Preoperative Values Research Articles

Use of Branched EVAR in Treatment of Juxtarenal Aortic Aneurysm and Essential Accessory Renal Artery: Another Tool on the Shelf? A Case Report.

We present the case of a 58-year-old male patient referred to our department from a smaller facility for further evaluation and treatment strategy regarding the choice between open or endovascular surgery. The patient was diagnosed with a 6cm asymptomatic juxtarenal aortic aneurysm and a 5mm diameter accessory renal artery (ARA) supplying the lower half of left kidney. Further diagnostic assessments indicated that the left ARA was perfusing over 40% of the left kidney. Given the patient's significant pre-existing medical conditions and elevated perioperative risk, the decision was made to proceed with minimally invasive endovascular surgery using a custom-made 5-branches stent graft (BEVAR). In the early postoperative period, the patient reported left flank pain. A subsequent CT scan identified a partial infarction in the left kidney due to the occlusion of an early small branch from the upper left renal artery. However, laboratory results showed no significant change in renal function compared to preoperative values. The patient was discharged 6 days post-surgery, with no additional complications observed during the early postoperative period. This case report demonstrates that BEVAR is acceptable technique with satisfactory early postoperative outcomes for treating juxtarenal aortic aneurysms with an accessory renal artery in patients who are high-risk candidates for open repair and anatomically unsuitable for FEVAR or Ch-EVAR procedures.

Canaloplasty via an ab-interno surgical technique in patients with primary angle closure glaucoma

PurposeTo investigate the clinical outcomes of canaloplasty performed with the iTrack microcatheter (Nova Eye Medical, Fremont, USA) as a standalone procedure and in combination with phacoemulsification in patients with primary angle-closure glaucoma (PACG).MethodsA single-center, retrospective case series of eyes undergoing canaloplasty via an ab-interno technique with a diagnosis of PACG based on gonioscopy findings (Shaffer grading). Patients were excluded if they had previously undergone a glaucoma procedure other than Laser Peripheral Iridotomy (LPI). Eyes were grouped by glaucoma severity based on mean deviation preoperative values. Outcome measures included intraocular pressure (IOP) and number of glaucoma medications.ResultsSixty eyes (9 canaloplasty-standalone, pseudophakic, and 51 canaloplasty + phaco) were eligible. The mean baseline IOP was 21.9 ± 7.3 mmHg and number of glaucoma medications was 1.95 ± 1.4. At the latest follow-up (mean 26 ± 9.2 months), they were reduced to 14.6 ± 3.7 mmHg (p < 0.001) and 0.96 ± 1.2 (p < 0.001). IOP reduction was statistically significant when canaloplasty was performed as a standalone procedure (baseline 22.78 ± 6.72 vs 17.00 ± 3.42 at the latest follow-up) or combined with phacoemulsification (21.75 ± 7.43 vs 14.21 ± 3.66) or if canaloplasty was performed in mild (20.8 ± 4.93 vs 15.5 ± 3.63), moderate (21.9 ± 8.58 vs 13.9 ± 3.90) or severe (23.5 ± 11.3 vs 12.4 ± 3.20) glaucoma eyes, with no difference between the groups postoperatively. Medication reduction was significant when canaloplasty was performed in combination with phacoemulsification and in mild glaucoma eyes. No serious intraoperative or postoperative complications were reported.ConclusionCanaloplasty via an ab-interno surgical technique, performed as standalone or combined with phacoemulsification, is a safe and clinically effective treatment in primary angle closure glaucoma patients up to 2 years.

Clinical effect analysis of vertebroplasty with high viscosity and standard bone cement for Kummell disease.

This study aims to observe and compare the effects of high-viscosity bone cement versus standard bone cement on the postoperative outcomes of percutaneous vertebroplasty (PVP) in patients with Kummell disease. A retrospective analysis was conducted on 135 patients with Kummell disease who underwent PVP between January 2019 and May 2023. Patients were divided into 2 groups: the high-viscosity group (group H, 63 cases) received high-viscosity bone cement during surgery, while the standard group (group S, 72 cases) received standard bone cement. Surgery duration, bone cement volume, bone cement leakage rate, as well as preoperative and postoperative evaluations using the Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), anterior vertebral height, and kyphotic Cobb angle were recorded and compared between the 2 groups. In the group H, significant improvements were observed in VAS scores, ODI, anterior vertebral height, and Cobb angle at 24 hours, 3 months, and 1 year postoperatively compared to preoperative values (P < .01). In the group S, VAS scores and ODI showed significant improvement at 24 hours, 3 months, and 1 year postoperatively (P < .01), but there were no significant differences in anterior vertebral height or Cobb angle compared to preoperative values (P > .05). Comparatively, the group H demonstrated superior outcomes in terms of bone cement volume, leakage rate, recovery of anterior vertebral height, and Cobb angle correction at 24 hours, 3 months, and 1 year postoperatively (P < .05). However, there were no significant differences between the 2 groups in terms of surgery duration, VAS scores, and ODI at the same time points (P > .05). PVP is an effective treatment for Kummell disease, providing significant pain relief and improved spinal function. The use of high-viscosity bone cement allows for greater volume infusion, better restoration of vertebral height, and correction of deformities, while also reducing the risk of cement leakage.

The Effects of Laparoscopic Sleeve Gastrectomy on Body Mass Index (BMI) and Glycated Hemoglobin (HbA1c) Levels.

Background and significance Bariatric surgery is an effective surgical intervention for weight loss and metabolic improvement. Articles tackling obesity and bariatric surgery with its preoperative preferences and postoperative findings are needed. From that stance, we aim to accurately document the impact of bariatric surgery, particularly laparoscopic sleeve gastrectomy (LSG), on body mass index (BMI) and glycated hemoglobin (HbA1c) levels. Patients and methods We present a retrospective cohort study conducted on 111 LSG patients from a total of 1633 patients who underwent bariatric surgery from January 23, 2018, to December 31, 2019, at King Saud University Medical City in Riyadh, Saudi Arabia. Patients were divided into three groups: nondiabetics, prediabetics, and diabetics. For each group, demographic characteristics as well as preoperative and postoperative BMI and HbA1c values were collected. Results The mean patient age was 41.35±11.8 years, with 56.8% being female. Our analysis showed that BMI values for all three groups had a significant and nearly similar overall decrease in value postoperatively (mean difference: 14.43, p<0.001). HbA1c levels also significantly improved, with the largest reduction seen in the diabetic group (from 8.7±1.5 to 6.6±1.4, p<0.001), followed by the prediabetic group (from 5.9±0.2 to 5.4±0.3, p<0.001) and the nondiabetic group (from 5.4±0.1 to 5.2±0.3, p=0.003). Conclusion LSG leads to significant improvements in BMI and HbA1c levels. Postoperatively, diabetic patients showed the greatest reduction in HbA1c percentage, supporting LSG's role in enhancing metabolic health.

Systemic inflammatory markers: Predictors of survival in mucinous appendix cancer patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

IntroductionInflammatory markers have been investigated as predictors of prognosis in various malignancies, but their role in mucinous appendix cancer (MAC) remains controversial. We evaluated the association between complete blood count-derived markers and survival in MAC patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). MethodsWe conducted a retrospective analysis of a single-center database (1998–2023) including newly diagnosed MAC patients who underwent complete (CC-0/1) CRS/HIPEC. Preoperative values of neutrophil-to-lymphocyte ratio (NLR), derived NLR, platelets-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated. For markers strongly associated with survival, we used time-dependent ROC analysis to define cutoffs to predict 5-year overall survival (OS). The Kaplan-Meier method with and Cox regression were employed for survival analysis. ResultsOf 626 CRS/HIPEC cases, 211 were eligible. NLR (p=0.049), dNLR (p=0.049), and MLR (p<0.001) were significantly associated with OS, while PLR was not. MLR demonstrated the strongest prognostic power (AUC=0.682) with the optimal cut-off 0.29. There were no significant differences in age, grade, or peritoneal cancer index (PCI) between patients with MLR<0.29 and MLR≥0.29. Five-year progression-free (PFS) and OS were 72.2 % and 83.2 % for MLR<0.29 and 54.2 % and 66.6 % for MLR≥0.29, respectively. After adjusting for age, PCI, and grade, MLR≥0.29 was associated with worse 3-year PFS (hazard ratio [HR] 1.74, 95 % confidence interval [CI]:1.02–2.97, p=0.044) and 3-year and 5-year OS (HR 1.87, 95 %CI: 1.00–3.47, p=0.049). ConclusionMLR has emerged as an independent predictor of survival in MAC patients undergoing CRS/HIPEC. Along with other prognostic factors, MLR≥0.29 may be potentially used for preoperative risk stratification.

Structural and Functional Alterations of the Deltoid Muscle After Arthroscopic Rotator Cuff Repair: A 2-Year Longitudinal Observation Study.

Deltoid muscle detachment and atrophy have been reported to occur after shoulder surgery. To investigate the 2-year changes in deltoid muscle structure and function after arthroscopic rotator cuff repair (ARCR) using magnetic resonance imaging (MRI) and electrophysical examination. Case series; Level of evidence, 4. A total of 72 patients (72 shoulders) who underwent ARCR between 2015 and 2020 were enrolled. Whole deltoid muscle volume and regional (anterior, lateral, and posterior) muscle thicknesses were determined on T2-weighted MRI scans of both shoulders taken preoperatively and at 1, 3, 6, 12, and 24 months postoperatively, and their correlations with compound muscle action potentials (CMAPs), shoulder abduction muscle strength, and Constant scores were investigated. Comparison between groups was performed using paired or Student t tests, and the relationship between deltoid muscle volume and various factors was determined using Pearson correlation analysis. The volume of the deltoid muscle on the affected side decreased from 44,369 ± 12,371 mm3 preoperatively to 38,139 ± 10,615 mm3 at 1 month postoperatively (P < .05), representing a 14% decrease. The deltoid muscle volume of the contralateral side also significantly decreased during the same time frame, from 43,278 ± 12,248 to 40,273 ± 11,464 mm3 (P < .05), representing a 7% decrease at 1 month postoperatively. Subsequently, the deltoid muscle volume on both sides recovered to preoperative levels at 12 months and was maintained at 24 months. Only the thickness of the anterior part of the deltoid was markedly decreased, from 13.9 ± 3.7 mm preoperatively to 12.0 ± 3.2 mm at 1 month postoperatively (P < .05), representing a 14% reduction. The CMAP amplitude showed a significant decrease at 1 month postoperatively; however, no significant difference was observed after 12 months when compared with the preoperative values or the values on the contralateral side. Positive correlations were found between deltoid muscle volume and CMAP amplitude at 24 months as well as between deltoid muscle volume and shoulder abduction muscle strength (R 2 = 0.698; P < .05) and Constant score (R 2 = 0.133; P < .05). Our study demonstrated that the early structural and functional decline of the deltoid muscle after ARCR was fully recovered within 1 year, confirming that this procedure does not negatively affect the deltoid muscle.

Preoperative Joint Line Convergence Angle as an Indicator of Clinical Outcomes and Accuracy of Alignment Correction After Double-Level Osteotomy.

The relationship between postoperative alignment and clinical outcomes after double-level osteotomy (DLO) has not been clarified. To examine the radiological and clinical outcomes after DLO and specifically evaluate the influence of the joint-line convergence angle (JLCA) on the accuracy of alignment correction and surgical outcomes. Case-control study; Level of evidence, 3. Included were 74 knees in 51 patients (mean age, 61.0 years) who underwent DLO for varus osteoarthritic knees and who had a minimum of 2 years of follow-up. The target hip-knee-ankle angle (HKAA) for the intended limb alignment was set to 1° valgus. The lateral distal femoral angle, medial proximal tibial angle, JLCA, and HKAA were measured on preoperative and postoperative radiographs. Outliers in alignment correction were defined as a deviation of ≥3° from the originally intended HKAA. Clinical outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). In the data analysis, the influence of the radiological parameters on the postoperative outcomes was statistically assessed. Radiological and clinical evaluation at 2-year follow-up showed significant improvement from preoperative values (P < .001). The HKAA was corrected from 13.4°± 3.0° varus preoperatively to 0.5°± 2.8° varus at 2 years, indicating a slight undercorrection. Regarding clinical outcomes, significant pre- to postoperative improvement was found on the KOOS (from 185.0 ± 71.2 to 387.9 ± 70.5; P < .001). Overall, 22 of the 74 knees (29.7%) were deemed to be outliers at the 2-year follow-up (19 knees [25.7%] in undercorrection, 3 knees [4.1%] in overcorrection). Postoperative KOOS values were significantly worse in the outliers than in the nonoutliers (344.4 ± 77.7 vs 405.8 ± 59.3; P < .001), and both pre- and postoperative JLCA was significantly larger in the outlier group. The receiver operating characteristic curve analysis indicated a preoperative cutoff JLCA of 6.0° for predicting postoperative alignment outliers. A preoperative JLCA of ≥6° was found to be a significant prognostic factor affecting the radiological and clinical outcomes after DLO for varus osteoarthritic knees by compromising the accuracy of deformity correction, resulting in suboptimal postoperative alignment.

Prediction of angular correction following first metatarsal-phalangeal joint arthrodesis.

The literature has established that the first metatarsal-phalangeal joint arthrodesis procedure will provide some correction of the first intermetatarsal and hallux valgus angles. But while this has previously primarily been investigated as a simple association (i.e. comparison of pre-operative to post-operative values), the objective of this investigation was to consider angular change as a continuous variable and to specifically correlate it with pre-operative values. Radiographs from 100 consecutive first metatarsal-phalangeal joint arthrodeses meeting selection criteria were evaluated. A negative Pearson correlation coefficient was observed between the pre-operative first intermetatarsal angle and intraoperative change in the first intermetatarsal angle (Pearson -0.547; p<0.001). In other words, with progressively increased levels of pre-operative intermetatarsal angle deformity, one should expect greater intermetatarsal angle correction. The relationship is described by the equation Y = 2.82 – 0.38X indicating that for every one degree of pre-operative intermetatarsal deformity over approximately 7 degrees, 0.38 degrees of post-operative correction might be expected. A negative Pearson correlation was observed between the pre-operative hallux valgus angle and the intraoperative change in the first hallux valgus angle (Pearson -0.806; p<0.001). In other words, with progressively increased levels of pre-operative hallux valgus angle deformity, one should expect greater hallux valgus correction. The relationship is described by the equation Y = 5.5 – 0.63X indicating that for every one degree of pre-operative hallux valgus angle deformity over approximately 9 degrees, 0.63 degrees of hallux valgus angle post-operative correction might be expected. Results of this investigation demonstrate a statistical correlation between pre-operative radiographic deformity and intermetatarsal angle and hallux valgus angle post-operative correction, and might provide foot and ankle surgeons with a degree pre-operative prediction of expected angular correction following the procedure. Level of Evidence3

Anatomic restoration of lateral humeral offset and humeral retroversion optimizes functional outcomes following reverse total shoulder arthroplasty

Cadaveric and computer simulations suggest lateral humeral offset (LHO) and humeral retroversion (HR) are associated with strength and range of motion (ROM) after reverse total shoulder arthroplasty (rTSA), butin vivodata is lacking. This study aimed to evaluate the effects of implant parameters (i.e. LHO and HR) on strength and ROM. LHO and HR were measured using pre-operative and post-operative computed tomography (CT) scans. Postoperative strength was measured across three planes of motion using a Biodex isokinetic dynamometer. Postoperative active and passive ROM during forward elevation, external rotation (ER), and internal rotation (IR) were assessed using a goniometer or spinal level. 30 rTSA patients (14 M, 16F, age: 71.8 ± 6.7yrs) participated with an average postoperative follow-up of 2.4 ± 1.1 years. Regarding strength, higher post-op LHO values were predictive of greater postoperative strength across all movements. However, lateralization of the implant beyond pre-op values (i.e. post-op LHO > pre-op LHO) was associated with poorer strength performance across all ranges of motion. Similar to strength outcomes, greater deviations from pre-op LHO was predictive of poorer IR ROM. Lastly, patients with minimal deviations in HR (post-op HR within 10° of pre-op HR) and minimal deviations in LHO (post-op LHO ≤ pre-op LHO) displayed the greatest postoperative ER ROM. Anatomic restoration of LHO combined with anatomic restoration of HR may be ideal for maximizing strength and ROM following rTSA. Overlateralization beyond anatomic may have negative consequences. Optimal implant lateralization and version may need to be individualized based on preoperative values.

Efficacy of the Coronoid Notch and Occlusal Plane As Predictable Landmarks for Determining the Medial Cut Height in Bilateral Sagittal Split Osteotomy: A Split-Mouth Observational Study.

This split-mouth observational study was conducted to assess the reliability and safety of using the coronoid notch and occlusal plane as landmarks to aid surgeons during bilateral sagittal split osteotomy(BSSO). Thirteen patients between the ages of 18 and 30 years, with class II and class III mandibular skeletal malocclusion requiring BSSO, were randomly selected and assigned to each of the study and control groups. A split-mouth study was chosen to conduct this research. Cone beam computed tomography (CBCT) imaging was conducted before the surgery to evaluate the anatomical structure, and three predefined points were marked at the superiormost point of the mandibular foramen, the inferiormost point of the mandibular foramen, and the deepest point of the sigmoid notch. A conventional sagittal split osteotomy was carried out in the control group. Preoperative values were obtained in the study group using the CBCT imaging technique by drawing an imaginary line from the inferiormost part of the mandibular foramen to the line corresponding to the occlusal plane that extended beyond the last molar. The lingual flap reflection was restricted to the internal oblique ridge. The posterior border of the mandible was not reflected. The measurements acquired via CBCT imaging were accurately transferred to the intraoperative surgical site using a vernier caliper. This facilitated the precise completion of the horizontal osteotomy, ascending ramus cuts, and vertical osteotomies. BSSO was performed, the mandibular setback or advancement was done with intermaxillary fixation, and the procedure was completed by rigid fixation. Types of lingual splits, types of lateral bone cut ends (LBCEs), any unfavorable split, and the time taken for the surgery (in minutes) were assessed. The surgery time in the control group (20.1538 ± 2.85325 min) was found to be higher than that in the study group (17.6154 ± 3.59487 min), with a p-value of 0.02. No significant differences were observed when assessing the presence of unfavorable splits in both groups (p = 0.500). Buccal LBCEs were the most prevalent, followed by inferior types. Type I lingual split was the most common in the study group (70%). This technique offers a dependable anatomical reference and significantly reduces surgical time for beginners. Additionally, the patterns of the lingual split were correlated with the types of lateral bone cut ends.

Identifying high-risk groups for deep vein thrombosis after primary total knee arthroplasty using preoperative Caprini scores and D-dimer levels.

Caprini score and D-dimer are well-recognized markers in deep vein thrombosis (DVT) assessment. However, their utility in guiding post-arthroplasty DVT risk is hampered by susceptibility to various post-operative factors, limiting their effectiveness as reminders. Conversely, these markers exhibit greater stability in the pre-operative setting. Despite this, research on the pre-operative predictive value of Caprini score and D-dimer for DVT following primary total knee arthroplasty (TKA) remains scarce. In a retrospective study, we analyzed data from patients who underwent primary TKA, between August 2015 and December 2022. Upon admission, Caprini scores were assessed, and comprehensive blood panels were obtained from fasting blood samples. For all patients, lower limb vascular Doppler ultrasonography was performed pre-operatively to exclude those with pre-existing DVT, and all patients underwent DVT examination again post-operatively. Our study included 2,873 patients, averaging 67.98 ± 7.54years, including 676 men and 2,197 women. In this study, 303 (10.55%) patients developed postoperative DVT, and 57 (1.98%) cases presented with lower limb symptoms. DVT incidence in patients with pre-operative Caprini scores of 1-2 (6.50%), 3 (10.28%), and ≥ 4 (18.05%) showed significant differences (P < 0.05). DVT rates were 14.80% in patients with pre-operative D-dimer levels of ≥ 1mg/L, higher than the 8.98% in those with levels of < 0.5mg/L, and 10.61% in those with levels 0.5-1mg/L (P < 0.05). In patients with Caprini scores of 1-2 and D-dimer levels ≤ 0.5mg/L, the occurrence rate of postoperative DVT was only 5.84%. For patients with Caprini scores ≥ 4 and D-dimer levels ≥ 1.0mg/L, the postoperative DVT occurrence rate soared to 24.81%, with the OR(odds ratio) was 4.744 compared to the former group. Patients with preoperative higher Caprini scores and D-dimer are more likely to develop DVT after TKA. Additionally, those with a preoperative Caprini score ≥ 4 and D-dimer level ≥ 1.0mg/L have a significantly increased risk (24.81%) of developing DVT, identifying them as a high-risk group for DVT following TKA. These findings hold significant value for DVT risk stratification in primary TKA patients and the formulation of preoperative interventions to mitigate the risk of DVT.

Old but gold: Is the Judet procedure still a viable option for posttraumatic knee stiffness in 2024? A comprehensive systematic review and meta-analysis.

Posttraumatic extension contracture of the knee (PECK) is common after knee injury. Initial management is conservative to improve the range of motion; if it fails, surgery may be necessary. This systematic review analyses existing literature on Judet quadricepsplasty for PECK. We will assess clinical outcomes, complications, patient satisfaction and factors that may influence its success. A search was conducted on 25 November 2023, adhering to preferred reporting items for systematic reviews and meta-analyses guidelines. PubMed, Embase and Google Scholar were used. Search strings were ([Judet] OR [quadricepsplasty]) AND (knee) AND (stiffness) and ([Judet] OR [quadricepsplasty]) AND (knee). Inclusion criteria: English articles focused on PECK, published between 2003 and 2023, and a minimum follow-up of 24 months. Exclusion criteria: case reports, alternative techniques, knee stiffness cases not only due to trauma, a sample size of <10 patients and articles not reporting functional outcomes. Among selected studies, 239 patients were considered. The average time between injury and Judet was 27 months. The population was predominantly male; the mean follow-up was 33 months. An average intraoperative knee range of motion improvement of 79.1 degrees (confidence interval 76.9; 81.3) compared to the average preoperative starting value of 30.7 degrees was observed. This improvement decreased by 13.5 degrees at the first postoperative check and by an additional 2.4 degrees at the follow-up, while maintaining an average value of bending above 90 degrees. Judet quadricepsplasty appears an effective technique for the management of PECK. The heterogeneity of included studies and the absence of standardized outcome measures limit the ability to draw definitive conclusions. Level III.

Assessment of clinical efficacy and safety of ICL implantation in patients with relatively shallow anterior chamber depth in early and midterm postoperative time

ObjectiveTo investigate the clinical effect and safety of ICL implantation in myopic patients with relatively shallow anterior chamber depth ( ACD ). MethodsRetrospective analysis,comparative, non-interventional case series. Patients with myopia who underwent ICL implantation were included in the study and were categorized into two groups: one with a relatively shallow ACD ( 2.60 mm ≤ ACD ＜ 2.80 mm ) and the other with a normal ACD ( ACD ≥ 2.80 mm ). Each group comprised 51 eyes and were reviewed for at least 6 months. To evaluate preoperative and postoperative visual acuity, intraocular pressure ( IOP ), central vault, ACD, endothelial cell density ( ECD ) and anterior chamber angle parameters( trabecular iris angle ( TIA ), angle opening distance at 500 μm and 750 μm ( AOD500, AOD750 ), trabecular iris space area at 500 μm and 750 μm ( TISA500, TISA750 ). Analyze the trend of postoperative data changes of 1 week, 1 month, 3 months, and at least 6 months. Patients in relatively shallow ACD with vault <100 μm or >1000 μm were performed detailed follow-up. ResultThe postoperative uncorrected distance visual acuity ( UDVA ) and best corrected visual acuity ( BCVA ) surpassed the preoperative BCVA in two groups. The group differences of effectiveness index ( EI ) was p=0.409 and of safety index ( SI ) was p=0.563. The EI were 1.07 and 1.09, SI were1.10 and 1.21. Postoperative vision and refractive error were effectively corrected. The preoperative and postoperative IOP and ECD values of the two groups were within the normal range, and the preoperative and postoperative differences and the group differences of IOP and ECD were p=0.649, p=0.501, p=0.222, p=0.276. The ACD in two groups were reduced by approximately 25% and 26%, the nasal and temporal TIA were reduced to 45% and 50% approximately. The nasal and temporal AOD500, AOD750, TISA500, and TISA750 in the relatively shallow ACD group were reduced 40% approximately and in the normal ACD group were reduced to 30% approximately. All the preoperative and postoperative differences and the group differences of anterior segment parameters were statistically significant ( all p<0.01 ), with more significant anterior segment changes in normal ACD group.The postoperative data in two groups showed that when the follow-up time was prolonged, the central vault was decreasing, and the postoperative ACD was increasing, the postoperative TIA increased slowly in relatively shallow ACD group and decreased slowly in normal ACD group, temporal TIA were greater than nasal TIA, with no significant variation. There were four eyes in the relatively shallow ACD group in the remarkable abnormal postoperative central vault. Three eyes had second operation: one eye had an ICL alignment, and two eyes had ICL replacement. ConclusionPatients with relatively shallow ACD who underwent ICL implantation had fine postoperative clinical efficacy and safety.

Mid-level data fusion strategy based on urinary nucleosides SERS spectra and blood CEA levels for enhanced preoperative detection of lymph node metastasis in colorectal cancer

BackgroundPreoperative prediction of lymph node metastasis (LNM) plays a crucial role in the treatment and prognosis of colorectal cancer (CRC). The traditional histopathological examination is invasive and time-consuming, providing pathological features only postoperatively. Preoperative serum carcinoembryonic antigen (CEA) is strongly correlated with postoperative LN status. However, the detection accuracy of LNM based on a single preoperative CEA level is low. Therefore, developing a more powerful and sensitive diagnostic tool would be of great clinical value for improving the accurate preoperative prediction of LNM in CRC patients. ResultsThis study aimed to develop a mid-level fusion approach using urinary nucleosides Raman spectra and blood CEA data to enhance the preoperative discrimination of CRC patients with and without LNM. Surface-enhanced Raman scattering (SERS) spectra of urinary modified nucleosides, isolated by affinity chromatography, were first acquired from 48 patients with LNM and 49 patients without LNM. The principal component analysis (PCA) scores obtained from the SERS spectra were then combined with preoperative blood CEA values to create a fused data array. The discriminant accuracy based on either dataset alone or the fused data was evaluated using three machine learning algorithms: linear discriminant analysis, k-nearest neighbors, and support vector machine. Results showed that the fused data could discriminate between the two groups with an accuracy of up to 91 %, outperforming SERS alone (86 %) and CEA alone (69 %). SignificanceTo our knowledge, this is the first report of mid-level data fusion of urinary nucleosides SERS spectra with blood CEA levels for the preoperative prediction of LNM in CRC. This work demonstrates that the mid-level data fusion strategy aided by SVM algorithm can greatly improve the preoperative prediction accuracy of LNM. This is crucial for therapeutic decision-making and prognostic assessment in CRC.

Preoperative interhemispheric coherence as a potential predictive marker for seizure outcome after total corpus callosotomy in nonlesional generalized epilepsy: a scalp EEG study.

Corpus callosotomy (CC) is one of the palliative epilepsy surgical procedures available for nonlesional generalized epilepsy, but it is more invasive than other palliative surgical procedures. The main challenge is proper selection of suitable patients for CC. Coherence analysis is a method for evaluating brain connectivity, but the correlation between preoperative coherence and surgical outcomes has not previously been clarified. The authors aimed to evaluate correlations between preoperative interhemispheric coherence and surgical outcome in patients with nonlesional generalized epilepsy. This retrospective study investigated patients with nonlesional generalized epilepsy who underwent total CC. The authors collected data for patients with good seizure outcome (Oguni classification A or B) and bad seizure outcome (Oguni classification D). For coherence analysis, the authors selected a period without interictal discharges. Preoperative interhemispheric coherence values from 8 pairs of symmetrically opposite scalp electrodes were computed across 5 frequency bands. Then, the authors evaluated correlations between coherence and surgical outcomes. Forty patients were included (19 males and 21 females). The mean (range) age at the time of surgery was 5.1 (1-18) years. Seizure outcomes were good in 15 patients and bad in the other 25 patients. Age at onset of epilepsy, duration of epilepsy before surgery, age at time of surgery, and presence of epileptic spasm did not differ significantly between patients with good and bad seizure outcomes (p = 0.36, p = 0.14, p = 0.10, and p = 0.20, respectively). Significant correlations were identified between higher Fp1-Fp2 interhemispheric coherence values in the delta, theta, and alpha frequency bands and bad surgical outcomes (p = 0.0397, p = 0.0322, and p = 0.0476, respectively). The receiver operating characteristic curves of the Fp1-Fp2 coherence values in these frequency bands showed areas under the curve of 67%, 69%, and 67%, respectively. The optimal cutoff values for Fp1-Fp2 interhemispheric coherence to predict surgical outcomes were 55.6 for delta (66.7% sensitivity and 72.0% specificity), 55.9 for theta (60.0% sensitivity and 76.0% specificity), and 50.3 for alpha (53.3% sensitivity and 84.0% specificity). This is the first study to identify potential predictive factors for surgical outcomes based on preoperative interhemispheric coherence in nonlesional generalized epilepsy. Higher coherence between Fp1-Fp2 in the delta, theta, and alpha frequencies correlated with bad seizure outcome after CC.

Combination of closing-wedge distal femoral osteotomy and modified tibial plateau levelling osteotomy for the treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in dogs

Considering the prevalence of cranial cruciate ligament disease (CCLD) and concurrent medial patellar luxation (MPL) among dogs, and the concomitant bone deviations routinely identified, the aim of this study is to evaluate the efficacy of the combination between distal femoral osteotomy (DFO) and modified tibial plateau levelling osteotomy (mTPLO) for the treatment of MPL with distal femoral varus, tibial torsion, and CCLD. Dogs with concurrent MPL and CCLD that underwent DFO and mTPLO procedures were included. Subjective clinical evaluations of gait and pre-operative and immediate post-operative radiographic examinations were performed. Surgical data were documented. The anatomical lateral distal femoral angle (aLDFA), femoral varus angle, mechanical medial proximal tibial angle, and tibial plateau angle (TPA) were compared between the pre- and post-operative periods. A total of 12 dogs were included in this study. Closing-wedge DFO and mTPLO procedures were performed on 14 limbs. The mean pre-operative and post-operative aLDFA values were 104.8 ± 3.9° and 95.4 ± 2.4°, respectively. TPA values were 26.2 ± 3.7° pre-operatively and 6.3 ± 3.2° post-operatively. Bone healing was observed in 7.1 %, 71.3 %, and 85.5 % of patients at the first, second, and third follow-up, respectively. Lameness was resolved in 28.5 %, 78.5 %, and 100 % at 30, 60, and 90 days, respectively. No major peri- or post-operative complications were reported. The combination of mTPLO and DFO aligns the stifle extensor mechanism, promoting dynamic stabilization. It can be considered for the treatment of concurrent MPL and CCLD in dogs, performed as a single procedure, and is associated with favorable short-term outcomes.

Preoperative patient-reported outcome measures predict minimal clinically important difference and patient-acceptable symptomatic state following arthroscopic Bankart repair.

The aims of this study were to validate the minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds for Western Ontario Shoulder Instability Index (WOSI), Rowe score, American Shoulder and Elbow Surgeons (ASES), and visual analogue scale (VAS) scores following arthroscopic Bankart repair, and to identify preoperative threshold values of these scores that could predict the achievement of MCID and PASS. A retrospective review was conducted on 131 consecutive patients with anterior shoulder instability who underwent arthroscopic Bankart repair between January 2020 and January 2023. Inclusion criteria required at least one episode of shoulder instability and a minimum follow-up period of 12 months. Preoperative and one-year postoperative scores were assessed. MCID and PASS were estimated using distribution-based and anchor-based methods, respectively. Receiver operating characteristic curve analysis determined preoperative patient-reported outcome measure thresholds predictive of achieving MCID and PASS. MCID thresholds were determined as 169.6, 6.8, 7.2, and 1.1 for WOSI, Rowe, ASES, and VAS, respectively. PASS thresholds were calculated as ≤ 480, ≥ 80, ≥ 87, and ≤ 1 for WOSI, Rowe, ASES, and VAS, respectively. Preoperative thresholds of ≥ 760 (WOSI) and ≤ 50 (Rowe) predicted achieving MCID for WOSI score (p < 0.001). Preoperative thresholds of ≤ 60 (ASES) and ≥ 2 (VAS) predicted achieving MCID for VAS score (p < 0.001). A preoperative threshold of ≥ 40 (Rowe) predicted achieving PASS for Rowe score (p = 0.005). Preoperative thresholds of ≥ 50 (ASES; p = 0.002) and ≤ 2 (VAS; p < 0.001) predicted achieving PASS for the ASES score. Preoperative thresholds of ≥ 43 (ASES; p = 0.046) and ≤ 4 (VAS; p = 0.024) predicted achieving PASS for the VAS. This study defined MCID and PASS values for WOSI, Rowe, ASES, and VAS scores in patients undergoing arthroscopic Bankart repair. Higher preoperative functional scores may reduce the likelihood of achieving MCID but increase the likelihood of achieving the PASS. These findings provide valuable guidance for surgeons to counsel patients realistically regarding their expectations.

Hip Arthroscopy for Femoroacetabular Impingement Syndrome in High-Level Athletes: A 10-Year Follow-up.

Arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) has previously been reported to have favorable short-term results in high-level athletes. Less is known about long-term outcomes. To report outcomes 10 years after hip arthroscopy for FAIS in high-level athletes using validated patient-reported outcome measures (PROMs). Case series; Level of evidence, 4. Patients who underwent hip arthroscopy between November 2011 and January 2013 were included in a local hip arthroscopy registry and completed preoperative PROMs. At 10-year follow-up, the same PROMs were completed. Inclusion criteria were age <40 years at time of surgery, no prior hip surgeries, and a pre-symptomatic Hip Sports Activity Scale (HSAS) level of 7 or 8. The exclusion criterion was total hip arthroplasty at follow-up. The PROMs included the international Hip Outcome Tool-12 items (iHOT-12), the Copenhagen Hip and Groin Outcome Score (HAGOS), visual analog scale (VAS) for overall hip function, European Quality of Life-5 Dimensions questionnaire (EQ-5D) and European Quality of Life-visual analog scale (EQ-VAS), HSAS, and a single question on patient satisfaction. The rates of patients achieving minimal important change and reporting Patient Acceptable Symptom State (PASS) were reported for HAGOS and iHOT-12. For iHOT-12, preoperative results were compared with 1, 5, and 10-year follow-ups. A total of 45 patients (34 men, 11 women; 70 hips; mean age 24.4 years at time of surgery) were included, with 77 patients eligible for inclusion. Significant improvements (P < .001) were seen at 10-year follow-up in all HAGOS subscales: Symptoms, Pain, Daily Activity, Sports, Physical Activity, Quality of Life (50.3 vs 78.6, 59.2 vs 86.8, 65.9 vs 88.8, 37.1 vs 81.1, 24.4 vs 81.1, 32.1 vs 79.3), iHOT-12 (40.1 vs 81.6), EQ-5D (0.59 vs 0.89), EQ-VAS (65.6 vs 80.4), and VAS for overall hip function (48 vs 79). For iHOT-12, the largest change was seen between preoperative and 1-year follow-up values, with consistent results over time. There was no statistically significant difference between HSAS levels preoperatively and at 10-year follow-up (HSAS level 4), with 24% of patients reporting a HSAS level 7 or 8 at the follow-up. Of the patients, 93% reported satisfaction with the surgery. PASS was achieved in 82% for iHOT-12, with a range of 76% to 91% for HAGOS subscales. Furthermore, 93% exceeded the minimal important change for iHOT-12, and a range of 67% to 84% for HAGOS. In a high-level athletic population, significant improvements in long-term outcomes are reported after hip arthroscopy for FAIS, with patients reporting a high satisfaction rate. The results also show that the largest improvement occurs within the first postoperative year, with results being maintained for 10 years.

Clinical values of preoperative red blood cell distribution width and platelet parameters in patients with papillary thyroid carcinoma.

The prevalence of thyroid carcinoma is increasing, and papillary thyroid carcinoma (PTC) is the most frequent subtype. More and more attention is being concentrated on the association between inflammation indicators and malignant tumors. The aim of the present study was to analyze whether the preoperative red blood cell distribution width (RDW) and platelet parameters, including mean platelet volume (MPV) and platelet distribution width (PDW), can be applied to distinguish between patients with PTC or papillary thyroid microcarcinoma (PTMC) and healthy controls, and to explore the associations with clinicopathological characteristics. The study retrospectively compared the RDW, MPV and PDW values of 780 patients with PTC or PTMC against a healthy control group. Receiver operating characteristic (ROC) curves were conducted to determine diagnostic accuracy. Furthermore, the clinicopathological features of the patients with PTC or PTMC were compared between higher and lower platelet parameter groups based on the RDW, MPV and PDW values. Significantly higher preoperative RDW, MPV and PDW values were found in patients with PTC or PTMC compared with those of the healthy group. ROC curve analysis showed that the area under the curve (AUC) plus 95% confidence interval (95% CI) values of RDW, MPV and PDW were 0.808 (0.780-0.835), 0.771 (0.743-0.799) and 0.711 (0.681-0.742), respectively. When RDW and MPV were combined together, the AUC (95% CI) value was enhanced to 0.858 (0.835-0.881) for the patients with PTC. For the patients with PTMC, RDW, MPV and PDW had AUC (95% CI) values of 0.812 (0.783-0.840), 0.779 (0.749-0.808) and 0.718 (0.685-0.751), respectively. When RDW and MPV were combined together, the AUC (95% CI) value was enhanced to 0.858 (0.835-0.881). A higher RDW was significantly associated with being female, deeper tumor infiltration, and normal FT3 and FT4 levels. A higher PDW was significantly associated with elevated thyrotropin receptor antibody levels. In conclusion, as convenient and available inflammation indicators, RDW, PDW and MPV have diagnostic ability and can distinguish between patients with PTC or PTMC and healthy controls. In addition, the combined application of RDW and MPV can improve the diagnostic power. The values of RDW and MPV were associated with clinicopathological characteristics. To the best of our knowledge, this is the first study to prove the usefulness of preoperative RDW combined with MPV in diagnosing patients with PTC or PTMC.

Quarter Century Outcomes of Alumina Ceramic-on-Ceramic Total Hip Arthroplasty

BackgroundAlumina ceramic-on-ceramic (CoC) bearings were widely used in total hip arthroplasty (THA) due to their superior wear resistance and inert properties, making them ideal for young, active patients who require long-lasting implants. This study aimed to synthesize findings from previous reports, providing a comprehensive follow-up of at least 25 years on the clinical and radiologic outcomes, the prevalence of osteolysis, and implant survivorship in patients undergoing primary cementless CoC THA. MethodsWe have previously reported five-to-ten-year outcomes following the implementation of third-generation alumina-on-alumina bearings in a consecutive series of 100 primary cementless THAs. This report updates those results with a minimum follow-up of 25 years. Of the original cohort, 58 patients who had 67 hips were available for the latest follow-up. Clinical assessments were performed using the Harris Hip Score (HHS) and pain questionnaires. Radiographic evaluations were employed to assess implant fixation and osteolysis. ResultsAt the final follow-up, the implant survival rate was an impressive 96.3%, with revision of the implant as the endpoint. The mean HHS improved significantly from preoperative values to 90.1, indicating excellent functional outcomes. The incidence of ceramic-related noise increased over time, with three cases of ceramic head fractures requiring a change of bearings. Notably, the extent of stem notching observed in earlier reports did not show further progression. Radiologically, all implants demonstrated bony ingrowth with no signs of aseptic loosening or major osteolysis. ConclusionThe long-term (minimum 25-year) follow-up of alumina-on-alumina bearings in primary cementless THA demonstrates outstanding implant survivorship, excellent functional outcomes, and minimal adverse effects over twenty-five years. Despite some issues like ceramic-related noise and component fractures, the overall performance of CoC bearings remains highly encouraging, particularly suitable for young, active patients. Surgeons should provide appropriate education to both potential THA candidates and patients who already have THAs with CoC bearings.