Preliminary Clinical Outcomes Research Articles

C2 anatomical pedicle screw for C2 fixation under the concept of atlantoaxial joint distraction and fusion with intra-articular cages: technical note.

To describe a novel alternative technique for C2 fixation under the concept of atlantoaxial joint distraction and fusion with intra-articular Cages, and to report its preliminary clinical outcomes. Eighteen patients with basilar invagination and atlantoaxial dislocation underwent atlantoaxial joint distraction and fusion with intra-articular Cages. All patients had hypoplasia of the C2 isthmus prohibiting insertion of the pedicle screw. A new method, the C2 anatomical pedicle screw (C2APS) was used as an alternative. In this technique, we directly inserted screw into the C2 anatomical pedicle after facet joint distraction and Cage implementation. The trajectory mostly went through the anatomical pedicle, which completely bypasses the variated VA and decreases the risk of VA harm. The dense anatomical pedicle could provide robust and secure screw purchase. C2APS was indicated for 32 screws in 18 patients. Satisfactory C2APS placement was achieved in all patients. No VA injury was observed. Sufficient reduction and decompression were achieved in all cases. There were no cases of implant failure, and all patients demonstrated solid fusion. JOA scores improved from 14.6 ± 1.5 preoperatively, to 16.0 ± 0.8 at the final follow-up (p < 0.01). The measured radiographic indices for basilar invagination and atlantoaxial dislocation significantly improved. This novel technique can provide reliable fixation of the axis while eliminating VA injury. When placement of a C2 pedicle screw is not possible due to anatomical constraints, C2APS can be considered as a safe and efficient alternative when the technique of atlantoaxial joint distraction and fusion with intra-articular Cages was used.

Kyphectomy followed by self-sliding pedicle screw and translumbosacral rod impaction and fixation: a novel growth-friendly technique in myelomeningocele patients.

Congenital lumbar kyphosis is present in about 15% of patients with myelomeningocele. Worsening of deformity with complications such as chronic skin ulcers and bone exposure is common. In patients under 8years of age, treatment becomes even more challenging: in addition to resecting the apex of the kyphotic deformity, we should ideally stabilize the spine with fixation methods that do not interrupt the growth of the rib cage, associated with the challenging pelvic fixation in this population. The emergence of growth-friendly techniques has greatly benefited patients with early-onset deformity, allowing for correction and control of deviation without interrupting trunk growth, which is often already compromised in these patients. We describe the surgical technique and present preliminary clinical outcomes for a novel approach which combines self-sliding screws that allow for trunk growth with impaction of translumbosacral rods for distal fixation. Candidates for the technique were patients with myelomeningocele and congenital lumbar kyphosis, inability to assume supine position, and a history of skin ulcers, recurrent osteomyelitis and poor weight gain. They all lacked sensory or motor function below the level of the myelomeningocele. They underwent the same reconstruction technique after kyphectomy which combines self-sliding screws that allow for trunk growth with impaction of the translumbosacral rods for distal fixation. Case 1: Female; 4.5years old at surgery; 5year follow-up. 1 complication: loosening of one blocker. The child is doing well and did not require surgical revision. Mean growth per year: 9.5mm. Case 2: Male; 7.4Years old at surgery; 4year follow-up. 1 complication: post-surgical infection which required 2 debridements in the operating room and prolonged antibiotic therapy. Mean growth per year: 6mm. Case 3: Female; 5.5Years old at surgery; 27month follow-up. No complications reported so far. Mean growth per year: 9.42mm. None of the cases showed signs of sacral osteolysis or rod migration. To our knowledge, this is the first study that combines sliding screws with translumbosacral rod impaction. Although this technique has proven to be safe and effective, we are aware that the number of cases is limited and the follow-up is short. Further studies are necessary to confirm the method.

Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial.

Suicide remains a leading cause of death among veterans in the United States, and mild traumatic brain injury (mTBI) increases the risk of suicidal ideation (SI) and suicide attempts (SAs). mTBI worsens impulsivity and contributes to poor social and occupational functioning, which further increases the risk of SI and SAs. Repetitive transcranial magnetic stimulation is a neuromodulatory treatment approach that induces neuroplasticity, potentially repairing neurodamage. Intermittent theta burst stimulation (iTBS) is a second-generation form of transcranial magnetic stimulation that is safe, shorter in duration, displays a minimal side effect profile and is a promising treatment approach for impulsivity in mTBI. Our novel proposed treatment protocol uses frontal pole iTBS to target the ventromedial prefrontal cortex, which may reduce impulsivity by strengthening functional connectivity between the limbic system and frontal cortex, allowing for improved top-down control of impulsive reactions, including SI and SAs. The objectives of this study are to (1) develop an iTBS intervention for veterans with mTBI, impulsivity, and SI; (2) assess the feasibility and tolerability of the intervention; and (3) gather preliminary clinical outcome data on SI, impulsivity, and functions that will guide future studies. This is a pilot, double-blinded, randomized controlled trial. In developing this protocol, we referenced the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. We will enroll 56 participants (28 active iTBS and 28 sham iTBS). The iTBS intervention will be performed daily, 5 days a week, for 2 weeks. We will collect 10 validated, psychometric, quantitative outcome measures before, during, and after the intervention. Measures included will assess functioning, impulsivity, suicidality, posttraumatic stress disorder, and depressive symptoms. We will collect qualitative data through semistructured interviews to elicit feedback on the participants' experiences and symptoms. We will perform quantitative and qualitative analyses to (1) assess the feasibility, tolerability, and acceptability of the treatment; (2) gather advanced neuroimaging data to assess neural changes elicited by treatment; and (3) assess improvements in outcome measures of impulsivity and suicidality in veterans with mTBI. This study protocol was approved by the Edward Hines, Jr. VA Hospital Institutional Review Board (Hines IRB number 14-003). This novel treatment is a 5-year research project (April 1, 2023, to March 31, 2028) funded by the Veterans Administration Rehabilitation Research and Development service (CDA2 award IK2 RX002938). Study results will be disseminated at or before the project's end date in March 2028. We will provide preliminary evidence of the safety, feasibility, and acceptability of a novel frontal pole iTBS treatment for mTBI, impulsivity, SI and SAs, and functional deficits. ClinicalTrials.gov NCT05647044; https://clinicaltrials.gov/study/NCT05647044. PRR1-10.2196/58206.

Post-prostatectomy Magnetic Resonance-guided Radiotherapy on a 1.5 Tesla Magnetic Resonance Integrated Linear Accelerator: Feasibility, Toxicity, and Preliminary Clinical Outcomes.

This study aimed to prospectively investigate magnetic resonance (MR)-guided radiotherapy (MRgRT) for post-prostatectomy prostate cancer and report preliminary clinical outcomes. All included patients underwent salvage or adjuvant adaptive MRgRT on a 1.5T MR integrated linear accelerator (MR-LINAC). Gastrointestinal and genitourinary toxicities were assessed. The primary endpoint was the progression-free survival (PFS) rate estimated by Kaplan-Meier (KM) survival analysis. A progression event was defined as the first occurrence of biochemical failure, radiological progression, or death. Secondary endpoints were biochemical failure-free survival (bFFS) rate, radiological PFS (rPFS) rate, and ≥G2 adverse events. Thirty post-prostatectomy patients were enrolled and followed (median follow-up: 32.0 months; 3.0-48.1 months). Three patients had biochemical failure during follow-up. One patient developed pelvic node metastases. All patients were alive. The estimated PFS rates were 96.4% (95% confidence interval [95%CI]: 89.8%-100.0%) at 2 years and 78.8% (95%CI: 61.3%-100%) at 3 years. The estimated bFFS rates were 96.4% (95%CI: 89.8%-100%) /86.6%(95%CI: 73.4%-100%) at 2/3 years, respectively. The corresponding rPFS rates were 100% at 2 years and 92.3% (95%CI: 78.9%-100%) at 3 years, respectively. There was only one acute G2 GI adverse event (1/30, 3.33%) of abdominal pain occurred. Two late G2 events (one rectal bleeding and one urinary frequency) were scored (2/30, 6.67%). No ≥G3 events were observed. Our findings suggest the feasibility, excellent patient tolerance, and encouraging efficacy of post-prostatectomy MRgRT, extending our knowledge of the clinical outcomes of MRgRT and serving as a benchmark for future investigation.

A novel coded healing abutment for a simplified digital workflow: A retrospective clinical study on 103 patients with a one year follow-up

ObjectivesTo present the clinical results obtained using a novel coded healing abutment (CHA). MethodsWe evaluated 103 patients with fixed implant-supported zirconia restorations (90 single crowns, 26 partial dentures, and 6 full arches) manufactured via computer-aided-design/computer-assisted-manufacturing and starting from the point of intraoral scans of novel CHAs (i-Physio®, LYRA-ETK, Sallanches, France). Patients were followed for one year. We assessed the clinical precision of the final restorations at delivery (quality, fit, and occlusal and interproximal contacts), as well as hard and soft tissues stability and patient satisfaction at the one-year follow-up. All complications were recorded. ResultsThe quality of the restorations was high, with satisfactory marginal fits (96.8% of the cases), occlusal contacts (95.1%), and interproximal contacts (94.3%). Excellent hard and soft tissues stability were found at the one-year follow-up assessment, with few complications (0.9% biological, 4.9% mechanical, and 1.6% technical) for an overall restoration success rate of 92.3% at the patient level and 91.9% at the restoration level. Patient satisfaction was high. ConclusionsWithin the limits of this study (retrospective design, short follow-up time) this novel CHA, with high prosthetic precision and esthetics, was clinically reliable and promoted hard and soft tissue stability. Further studies on a larger sample of patients and a longer follow-up period are needed to confirm these preliminary clinical outcomes. Clinical relevanceHigh prosthetic precision can be achieved when scanning CHAs. CHAs simplify digital impressions, reduce the manipulation of soft tissues, and prepare them for scanning, thereby promoting tissue healing and stability over time. Additionally, CHAs can serve as temporary abutments for immediate, nonfunctional loading.

An exploratory study of service user and clinical outcomes in telehealth-delivered dialectical behavior therapy for adolescents skills groups.

The COVID-19 pandemic led many in-office therapeutic programs to pivot to virtual programming without empirical data supporting the acceptability and efficacy of the remote-delivered adaptations. These adaptations were essential for continuing care and addressing surging youth psychological problems at the time. To serve adolescents with comorbid psychiatric disorders and associated problems (e.g., emotion dysregulation), we adapted and implemented virtual and hybrid formats of a dialectical behavior therapy for adolescents (DBT-A; Rathus & Miller, 2015) program within a public university training clinic, such as separating the traditional multifamily group into adolescent-only and caregiver-only groups. Building on qualitative reports on virtual DBT-A, we explored preliminary service user and clinical outcomes of the virtual and hybrid DBT-A adolescent skills group component in a longitudinal retrospective cohort study for teenagers treated during the first 2 years of the pandemic (N = 21; 81% Hispanic/Latinx; 100% White). Aim 1 described service user outcomes (e.g., retention, group cohesion, client satisfaction) in the remote-delivered skills groups. Most youth completed treatment. Caregiver satisfaction was high, whereas adolescent satisfaction was mild. Aim 2 explored preliminary clinical outcomes of remote-delivered skills group adaptations. Overall anxiety, panic, and two emotion regulation facets (i.e., emotional awareness; goal pursuit when upset) significantly reduced across treatment. There were no significant reductions in depression. No suicide attempts or suicides occurred during the program. Further work is needed to clarify the efficacy of telehealth formats of DBT-A skills groups in larger, more racially diverse samples and to identify which adolescents are most appropriate for virtual and/or hybrid DBT-A. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Robotic uro-oncology applications of SSI Mantra™ robot

ObjectiveTo report our preliminary clinical experience and outcomes of uro-oncology procedures conducted utilizing the SSI Mantra™ robotic surgical platform. MethodsData of consecutive patients who underwent various robot assisted uro-oncology procedures using the SSI Mantra™ platform at our institution between July 2022 and September 2023 were recorded. The specific surgical configuration employed with the SSI Mantra™ for these procedures were duly noted. We assessed the feasibility of these procedures with this novel robotic platform and report the outcomes. ResultsA total of 156 patients were operated with the SSI Mantra™ system. The spectrum of procedures performed included robot-assisted laparoscopic radical prostatectomy with bilateral extended pelvic lymph node dissection (n=77), robot-assisted radical cystectomy with bilateral extended pelvic lymph node dissection with extra-corporeal urinary diversion (n=39), robot-assisted radical nephrectomy (n=32), robot-assisted partial nephrectomy (n=6), robot-assisted radical nephro-ureterectomy with bladder cuff excision (n=1) and bilateral robot-assisted video endoscopic inguinal lymph node dissection (n=1). One robot-assisted radical prostatectomy had to be converted to open in view of system malfunction. However, no system related intra-operative complications or injuries were encountered. ConclusionThe SSI Mantra™ system demonstrates significant promise as an innovative robotic platform. In this single center experience, we have demonstrated the feasibility of a diverse array of surgical procedures using this platform. Further research, involving a larger cohort of patients, is imperative to refine the operative techniques and comprehensively understand the perioperative outcomes of the SSI Mantra™ system, particularly in comparison to other robotic surgical platforms.

Robotic preperitoneal extended totally extraperitoneal (R-PeTEP) technique description for ventral hernia repair: preliminary results.

Transabdominal preperitoneal (TAPP) ventral hernia repair requires incising the peritoneum from within the abdominal cavity, developing a flap, and placing a reinforcing mesh after fascial closure from the preperitoneal space. We present a novel adaptation to this technique that allows placement of preperitoneal mesh without entering the abdominal cavity. The robotic totally extra- and preperitoneal (R-PeTEP) access for ventral hernia repair is best suited for small to moderate sized ventral hernias with concomitant diastasis recti. Our study is a retrospective review of all patients who underwent R-PeTEP from December 2022 to November 2023. A comprehensive description of the surgical technique is included. Patient demographics, hernia characteristics, as well as clinical outcomes are described. A total of 25 patients underwent R-PeTEP for ventral hernia repair with diastasis recti plication. The median age was 55years (IQR 43.5-63) and 92% (n = 23) were male. The median ASA score was 2 (IQR 1-2) and the median BMI was 30.4 (IQR 29.3-32.8) with 64% (n = 16) percent having a BMI ≥ 30. Median hernia width was 3cm (IQR 3-4), with a median diastasis recti width of 4cm (IQR 2.6-4) and length of 15cm (IQR 11.8-16). The median operative time was 120min (IQR 116-134). All repairs were reinforced with permanent mesh. Sixty-eight percent of the patients (n = 17) were discharged on the same day. With a median follow-up of 30days (IQR 16-107), 8% (n = 2) seromas, 16% (n = 4) developed clinically insignificant hematomas, and one patient (4%) developed ileus that was managed conservatively. This study establishes the feasibility and safety of R-PeTEP, which provides direct access to the preperitoneal space, avoiding disruption to the posterior rectus sheath, possibly reducing neurovascular bundle injuries, and omitting entry to the abdominal cavity. R-PeTEP facilitates wide flap creation for prosthetic overlap and allows for posterior plication of diastasis recti with little to no mesh fixation with overall excellent preliminary clinical outcomes.

Stereotactic body radiotherapy using CyberKnife versus interstitial brachytherapy in accelerated partial breast irradiation on left-sided breast: A comparison of dosimetric characteristics and preliminary clinical results

IntroductionWe compared the dosimetric characteristics of the target and organs at risk (OARs) as well as the preliminary clinical outcomes between two accelerated partial breast irradiation (APBI) techniques. MethodsForty-four patients diagnosed with left-sided early breast cancer who underwent APBI using either interstitial brachytherapy (IB) or stereotactic body radiation therapy (SBRT) with CyberKnife (CK) were retrospectively reviewed. The dosimetric parameters of the target and OARs were compared. Preliminary clinical outcomes, including tumor control and acute toxicity, were analyzed. ResultsTreatment plans with CK demonstrated a better cardiac dose-sparing effect. Radiation doses to the heart at V150cGy for the CK and IB groups were 24.4 % and 60.4 %, respectively (p < 0.001), while the mean heart doses for the CK and IB groups were 107.4 cGy and 204 cGy, respectively (p < 0.001). The heart D1c.c. and the ipsilateral lung received a lower dose in the IB group, without any significant differences. The median follow-up time in the CK and IB groups was 28.6 and 61.3 months, respectively. No patients died from either breast cancer or cardiac events during follow-up. A locoregional recurrence event at the neck occurred in one patient within the IB group. ConclusionsAPBI planned by CK was shown to have a better dose-sparing effect on the heart, as well as better conformity and homogeneity to the target. CK is a non-invasive treatment which showed minimal acute toxicity and promising tumor control.

803: Post-prostatectomy Radiotherapy with MR-LINAC: Feasibility, Safety and Preliminary clinical outcome

803: Post-prostatectomy Radiotherapy with MR-LINAC: Feasibility, Safety and Preliminary clinical outcome

2651: Preliminary clinical outcomes of adaptive prostate SBRT using a conventional linac

2651: Preliminary clinical outcomes of adaptive prostate SBRT using a conventional linac

Posterior-only approach cervical hemivertebrectomy and short fusion with pedicle screws in young children with cervical scoliosis: case report and technical note.

Cervical hemivertebrae (C3-6) causing significant osseous torticollis, head tilt and facial asymmetry are rare and complicated. Cervical hemivertebrectomy (CHVE) by a posterior-only approach was never reported because it is highly risky and its efficacy remains controversial. This study is to evaluate the feasibility and preliminary clinical outcomes of posterior-only approach for CHVE and torticollis correction in young children. Four young children aged 5-9 years old with significant torticollis caused by cervical hemivertebrae underwent deformity correction consisting of cervical pedicle screw (CPS) placement with O-arm-based intraoperative navigation, CHVE using ultrasonic bone scalpel and short-segmental posterior instrumentation and fusion. Details of this novel technique were presented. The preliminary short-term clinical and radiographic outcomes were assessed. On average, the operative time was 312.5 ± 49.9min, and the surgical blood loss was 375.0 ± 150.0ml. The structural cervical scoliosis was corrected from 31.5 ± 7.3° to 11.0 ± 4.1°, and the average correction rate was 64.9%. Head tilt was favorably corrected from 11.0 ± 4.2° to 3.5 ± 2.6°. The shoulder balance improved from 6.3 ± 1.3° to 1.5 ± 1.9°. One case with C6 CHVE had convex side radiating nerve root pain but no sign of muscle power weakness. Full recovery was achieved one month after surgery. No other complication occurred. CHVE by a posterior-only approach was a feasible alternative option for the treatment of congenital cervical scoliosis. It could resect the CHV effectively and achieve satisfactory torticollis correction without additional anterior access surgery. Successful CPS placement in this child population was essentially important to enable reliable osteotomy closure and firm posterior instrumentation.

Posterior Thoracic Antidisplacement and Fusion Surgery for a Special Type of Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine: Indications and Preliminary Clinical Results of 2-Year Follow-Up

To describe a novel technique, posterior thoracic antidisplacement and fusion (PTAF), for a special type of ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL), and to evaluate its safety and efficacy. From July to December 2020, 5 consecutive patients with beak-type T-OPLL located at the thoracic vertebral body level underwent PTAF surgery. Their demographic data, radiological parameters, perioperative complications, and surgery-related findings were recorded and analyzed. The surgical outcomes were assessed using a modified Japanese Orthopedic Association scale, and the recovery rate was calculated using the Hirabayashi's method. All patients were followed up for at least two years. The mean thickness of OPLL was 9.4±1.0mm, and the OPLL spinal canal occupying ratio was 67.7%±8.5%. Postoperatively, the mean antidisplacement distance of OPLL was 8.1±1.8mm, and the average shortened distance of the spinal column was 6.0±1.13mm. The mean operation time and blood loss were 158.2±26.3minutes and 460±89.4mL, respectively. Perioperative complications were cerebrospinal fluid leakage and instrument failure, 2 cases each. The mean modified Japanese Orthopedic Association score was increased from 3.6±2.9 before surgery to 9.4±3.0 at the last follow-up, and the average recovery rate was 84.2±30.5%. The preliminary clinical outcomes indicate that PTAF is a safe and effective method for the treatment of beak-type T-OPLL, which has its apex located at the vertebral body level and has a high spinal canal occupation ratio.

P-043 Preliminary clinical outcome using the Q300™ device in a reproductive laboratory environment

Abstract Study question How does the Q300™ Device impact clinical outcomes in a reproductive laboratory environment compared to established standards? Summary answer The device showed favorable clinical outcomes and was user-friendly. More research is needed to identify the patient subgroups that can benefit the most from system What is known already Embryologists struggle with accurately assessing sperm morphology without staining, prompting interest in emerging technologies like AI. These methods evaluate motility parameters, offering non-invasive sperm selection. A previous study comparing Q300 to manual staining methods showed high agreement and repeatability, indicating Q300’s accuracy in measuring live sperm cells. It aids in selecting cells per WHO2021 guidelines without staining, potentially revolutionizing sperm assessment. Study design, size, duration The study is an open-label, non-randomized study. Semen samples intended for ICSI were imaged by the Q300™ device before micro-injection to aid in selecting morphologically compliant sperm cells. The data collected was compared to the Key Performance Indicators (KPI) for ART laboratories according to the Vienna Consensus. Up to 5 sites will be enrolled in the study, with up to 100 couples in total from all sites. Study duration: 18 months Participants/materials, setting, methods The Q300™ device is an optical system using quantitative phase microscopy and holographic imaging to analyze human semen morphology. The device aids embryologists in selecting live and motile sperm cells for ICSI by providing automatic, objective analysis. Couples meeting inclusion criteria, including female age ≤40 and availability of motile sperm, were recruited for ICSI procedures. There were no restrictions on previous IVF/ICSI cycles. Endpoints: fertilization, day-3 embryo development, good blastocyst development rates, and implantation rates. Main results and the role of chance 14 couples were recruited from Barzilay Medical Center’s IVF unit in Ashkelon, Israel. The average fertilization rate is 79.1% (Vienna consensus competency is ≥ 65%), the day 3 embryo development rate is 55% (Vienna consensus competency is ≥ 45%), and the good blastocyst development rate is 42.5% (Vienna consensus competency is ≥ 30%). The implantation rate (day 3+day5) is 36.8% (Vienna consensus competency is ≥ 25% for day 3 embryo transfers and ≥ 35% for blastocyst transfers). The intended users performed the procedures with no reported malfunctions. 270 sperm imaging procedures were performed using the Q300 device to select 109 morphologically suitable cells for ICSI. The utilization of the product resulted in approximately a 40% yield of correct selections by the embryologist. Consequently, out of every 10 cells deemed compliant by the embryologist, only 4 were confirmed by the device, with roughly 3 falling within a margin of 10% around the WHO measurement range. Moreover, only about 1 of these selections fell within the boundaries defined by the WHO standards. This observation offers insights into the characteristics of cells routinely chosen for injection into oocytes. Limitations, reasons for caution The study recruited 14 couples from a single site; it is important to validate and statistically power the outcome measures and compare them with clinical control groups in the future. In the next generation of the product, incorporating an objective selection based on sperm motility can further improve its functionality. Wider implications of the findings The findings offer insights into optimizing sperm selection processes, potentially improving fertilization, embryo development, and implantation rates in couples undergoing ICSI. Moreover, the study highlights the importance of continued research and refinement of technological innovations in ART to better serve patient needs and improve treatment outcomes. Trial registration number NCT06232720

Preliminary Clinical and Radiological Outcomes of the "No-Punch" Decompression Techniques for Unilateral Biportal Endoscopic Spine Surgery.

To avoid the most offending surgical instrument for dural tears, we develop a "no-punch" decompression technique for unilateral biportal endoscopic (UBE) spine surgery. This retrospective study enrolled 68 consecutive patients with degenerative lumbar spinal stenosis segments. The treatment results were evaluated using the visual analogue scale (VAS) for low back and leg pain, the Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI). Radiological outcomes were evaluated using the preoperative and postoperative magnetic resonance imaging. This study included 36 male and 32 female patients who received 109 segments of decompression, with an average age of 68.7 (37-90 years). The average operation time was 52.2 minutes. The average hospital stay was 3.1 days. There were no dural tears but 3 minor surgical complications, all treated conservatively. The VAS for low back and leg pain improved from 4.6 and 7.0 to 0.8 and 1.2. The JOA score improved from 16.2 to 26.8, with an improvement rate of 82.0%. The ODI improved from 50.1 to 18.7. All these improvements were statistically significant. The cross-sectional dural area improved from 61.1 to 151.3 mm2, with an average increase of 90.2 mm2 and 205.3%. 87.1% of the ipsilateral facet joints and 84.7% of the contralateral facet joints were preserved. In 61% of the decompressed segments, the ipsilateral facet joints were preserved better than the contralateral facet joints. The UBE "no-punch" decompression technique effectively avoids the dural tears. It provides effective neural decompression, excellent facet joint preservation, and good treatment outcomes.

One-Step Intraoperative Optical Coherence Tomography Guided Tunnel, Mushroom Femtosecond Laser Big Bubble Deep Anterior Lamellar Keratoplasty.

The aim of our study is to investigate the feasibility and outcomes of using a femtosecond laser (FSL) platform (Ziemer LDV Z8) for deep anterior lamellar keratoplasty (DALK), enabling the creation of mushroom-shaped graft-host junctions, lamellar cuts, and intrastromal tunnels, to facilitate the big bubble, in one step. We included wet lab experiments on nine porcine eyes to assess the laser accuracy and cuts depth using an anterior segment (AS) OCT. This was followed by an interventional prospective case series on 10 eyes with variant corneal pathologies. The Z8 system, with in-built intraoperative optical coherence tomography (iOCT), guided corneal scans and directed the cuts. ASOCT showed visible mushroom configurations, lamellar cuts, and tunnels. Deviations from the target were 1.6%, 2.6%, and 3.5%. Anterior lamellar removal was easy in all clinical cases, including corneal scarring. The intrastromal tunnel was found at the preset location and the mushroom configuration was acquired. A big bubble was achieved in all cases. Type 1, 2, and 3 bubbles were formed in eight, one, and one case, respectively. We describe a new approach to DALK in which the in-built iOCT-guided FSL enables safe, precise, controlled, and reproducible desired cuts in one step. The preliminary clinical outcomes were favorable.

Robotic-assisted differential total knee arthroplasty with patient-specific implants: surgical techniques and preliminary results

ObjectiveIn total knee arthroplasty (TKA), achieving soft-tissue balance while retaining acceptable lower limb alignment is sometimes difficult and may lead to patient dissatisfaction. Theoretically, patient-specific implants can bring great benefits, while the lack of precise surgical tools may hinder the improvement of outcomes. The objective of this study was to illustrate surgical techniques and evaluate kinematics and early clinical outcomes of robotic-assisted TKA using patient-specific implants.MethodsBased on preoperative CT scan, femoral and tibial components were 3D printed. Medial and lateral tibial liners were separate with different thicknesses, posterior slopes and conformity. TiRobot Recon Robot was used for surgery, and was armed with smart tools that quantify gap, force and femoral-tibial track. We collected data on demographics, intraoperative gap balance and femoral-tibial motion. In the follow-up, we evaluated the range of motion, Visual Analogue Scale (VAS), forgotten joint score (FJS), Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR) score. Radiological data were also harvested.ResultsFifteen patients (17 knees) were enrolled with a mean age of 64.6 ± 6.4 (53–76) years. In 5 knees, we used symmetric tibial liners, the rest were asymmetric. After surgery, the average alignment was 1.6 ± 2.0 (-3–5) degrees varus. The average follow-up lasted 6.7 ± 4.2 (1–14) months. The mean visual analogue scale was 0.8 ± 0.7 (0–2), FJS was 62.4 ± 25.3 (0–87), KOOS was 86.5 ± 9.4 (57–97). 11 patients were “very satisfied”, 3 were “satisfied" with the result, and one patient was neutral due to restricted extension and unsatisfactory rehabilitation at five months’ follow-up.ConclusionsWith patient-specific implants and robotics, TKA could be performed by a mathematical way, which was dubbed a “differential” TKA. Intraoperative kinematics was excellent in terms of gap-force balancing and femoral-tibial relative motion. Preliminary clinical outcomes were overall satisfactory.

AAV2-GDNF Gene Delivery in Mild- and Moderate-Stages of Parkinson’s Disease: Preliminary Brain Imaging and Clinical Outcomes

AAV2-GDNF Gene Delivery in Mild- and Moderate-Stages of Parkinson’s Disease: Preliminary Brain Imaging and Clinical Outcomes

A unique model of care for youth in crisis: A pilot open trial.

Suicide is the second leading cause of death for those ages 10-24 years in the United States, and emergency department (ED) visits due to youth self-injurious thoughts and behaviors (SITB) and increased substantially between 2016 and 2021. Although ED services are essential for an effective system of care, the ED setting is typically not well-suited for the comprehensive, collaborative, and therapeutic evaluation of SITB; treatment planning; and care coordination that youth in a suicidal crisis need. As a result, an urgent care model for mental health designed to provide comprehensive crisis triage and intervention services is needed within outpatient psychiatry. This pilot trial examined the feasibility, acceptability, and preliminary clinical outcomes of a brief, urgent care model, the Behavioral Health Crisis Care Clinic (CCC), designed to provide comprehensive outpatient triage and intervention services aimed at reducing suicide risk for youth in crisis. Participants were 189 youth (ages 10-20; 62.4% females; 58% Caucasian) who had past-week suicidal ideation or behavior and their caregivers. The results demonstrated the CCC model exceeded feasibility and acceptability benchmarks based on the Service Satisfaction Scale (M score > 3.00). CCC care was associated with significant decreases in self-reported suicide risk based on the Collaborative Assessment and Management of Suicidality Suicide Status Form with low levels of ED usage during CCC care (7.7%) and 1-month posttreatment (11.8%). Over 88% of patients without established outpatient care at the time of referral were connected to care during CCC treatment, almost all of whom (95%) continued with ongoing mental health care 1 month after ending CCC care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clinical outcomes of self-glazed zirconia veneers produced by 3D gel deposition: a retrospective study

BackgroundSelf-glazed zirconia (SZ) restorations are made by a novel additive three-dimensional gel deposition approach, which are suitable for a straightforward completely digital workflow. SZ has recently been used as minimally invasive veneer, but its clinical outcomes have not been clarified yet. This study aimed to evaluate the preliminary clinical outcomes of SZ veneers compared with the widely used lithium disilicate glass–ceramic veneers made by either pressing (PG) or milling (MG) process.MethodsFifty-six patients treated with SZ, PG, and MG veneers by 2 specialists between June 2018 and October 2022 were identified. Patients were recalled for follow-up at least 1 year after restoration. Clinical outcomes were assessed by 2 independent evaluators according to the modified United States Public Health Service (USPHS) criteria. Overall patient satisfaction was assessed using visual analogue scale (VAS), and analyzed by one-way ANOVA. Chi-square test was applied to compare the difference in the success and survival rates among the 3 groups.ResultsA total of 51 patients restored with 45 SZ, 40 PG, and 41 MG veneers completed the study, with a patient dropout rate of 8.9%. Mean and standard deviation of follow-up period was 35.0 ± 14.7 months. All restorations performed well at baseline, except for 2 SZ veneers with mismatched color (rated Bravo). During follow-up, marginal discrepancy (rated Bravo) was found in 4 MG veneers and 1 PG veneer, and partially fractured (rated Charlie) was found in another 2 PG veneers. The survival rate of SZ, PG, and MG veneers was 100%, 95%, and 100%, with a success rate of 95.56%, 92.50%, and 90.24%, respectively, none of which were significantly different (p = 0.099 and 0.628, respectively). The mean VAS score of SZ, PG, and MG was 95.00 ± 1.57, 93.93 ± 2.40, and 94.89 ± 2.00 respectively, without significant difference (p > 0.05).ConclusionSZ veneers exhibited comparable preliminary clinical outcomes to PG and MG veneers, which could be considered as a feasible option for minimally invasive restorative treatment.