Reduction Of Group Research Articles

Surgical outcomes of acetabular fracture of elderly patients with superomedial dome impaction

This study aimed to investigate the outcomes of elderly acetabular fractures according to the reduction of impacted dome fragments. A retrospective cohort study was performed in two institutions. Fifty-four patients aged ≥ 60 years with acetabular fractures were enrolled. Data for dome impaction and postoperative reduction was collected. Patients were divided into the good reduction group (displacement ≤ 3 mm) and poor reduction group (displacement > 3 mm). Postoperative osteoarthritis (OA), Harris hip score (HHS), total hip arthroplasty conversion, good/poor outcomes were compared between the two groups. The good reduction group (N = 45) demonstrated a lower proportion of radiographic OA (18 vs. 77%, P = 0.001), higher HHS (82.1 vs. 68.6, P = 0.022), and higher proportion of good outcomes than the poor reduction group (N = 9) (89 vs. 22%, P < 0.001). In a subgroup analysis of the patients with dome impaction, the good reduction group had a higher proportion of good outcomes (80 vs. 20%, P = 0.031). On comparing within the good reduction group, dome impaction did not influence clinical outcomes. Elderly acetabular fractures demonstrated favorable outcomes when adequate reduction was achieved even with dome impaction. Well-reduced dome impaction could achieve satisfactory outcomes in elderly acetabular fractures.

Flawed groups and the topology of character varieties

A finitely presented group Γ is called flawed if Hom(Γ,G)//G deformation retracts onto its subspace Hom(Γ,K)/K for all reductive affine algebraic groups G and maximal compact subgroups K⊂G. After discussing generalities concerning flawed groups, we show that all finitely generated groups isomorphic to a free product of nilpotent groups are flawed. This unifies and generalizes all previously known classes of flawed groups. We also provide further evidence for the authors' conjecture that RAAGs are flawed. Lastly, we show direct products between finite groups and some flawed group are also flawed. These latter two theorems enlarge the known class of flawed groups.

Dissolved organic matter and Fe/Mn enhance the combination and transformation of As in Lake Chaohu Basin

The phenomenon of algal blooms resulting from lake eutrophication has the potential to increase the concentration of dissolved organic matter (DOM) and consequently influence the environmental behaviour of arsenic (As). In the subtropical region, the interplay between DOM, Fe/Mn and As becomes complex as Fe/Mn-rich substances from soils and sediments enter eutrophic lakes. The mechanisms by which DOM-Fe/Mn interactions affect the transformation of As species remain uncertain. Therefore, the Chaohu Lake Basin was selected as a representative case study site to investigate the levels of DOM, As, Fe and Mn in the water and to establish their associations. In addition, the interaction mechanism between DOM-Fe/Mn and As was investigated by elucidating the transformation behaviour of DOM-Fe/Mn on As species in a controlled laboratory environment. The results showed that in cases where the coexistence of Fe and Mn concentrations was relatively low (e.g. Fe < ∼0.5 mg/L and Mn < ∼0.6 mg/L), the concentration of As in water would increase proportionally with the simultaneous increase of both Fe and Mn concentrations (As < 5 μg/L). However, when the concentration of either Fe or Mn reached 10 mg/L, the proportion of As complexed by DOM increased significantly, reaching 99.73% and 99.66%, respectively. In the configuration of a metallic bridge, the elements Fe and Mn act as connectors between negatively charged DOM and As, thereby increasing the adsorption capacity of DOM for As. The alcohol and alkene functional groups present on the DOM-Fe/Mn surface show a preference for binding with free species of As in aqueous environments. In addition, the reductive groups on the surface of DOM not only directly convert As(V) to As(III), but also facilitate the reduction of Fe(III) to Fe(II), resulting in the indirect conversion of As(V) to As(III). Thus, this study provides a comprehensive understanding of the transport and transformation processes of arsenic in subtropical eutrophic lakes.

Universal filtered quantizations of nilpotent Slodowy slices

Every conic symplectic singularity admits a universal Poisson deformation and a universal filtered quantization, thanks to the work of Losev and Namikawa. We begin this paper by showing that every such variety admits a universal equivariant Poisson deformation and a universal equivariant quantization with respect to a reductive group acting on it by \mathbb{C}^\times -equivariant Poisson automorphisms. We go on to study these definitions in the context of nilpotent Slodowy slices. First, we give a complete description of the cases in which the finite W -algebra is a universal filtered quantization of the slice, building on the work of Lehn–Namikawa–Sorger. This leads to a near-complete classification of the filtered quantizations of nilpotent Slodowy slices. The subregular slices in non-simply laced Lie algebras are especially interesting: with some minor restrictions on Dynkin type, we prove that the finite W -algebra is a universal equivariant quantization with respect to the Dynkin automorphisms coming from the unfolding of the Dynkin diagram. This can be seen as a non-commutative analogue of Slodowy's theorem. Finally, we apply this result to give a presentation of the subregular finite W -algebra of type \mathsf{B} as a quotient of a shifted Yangian.

Computational aspects of Calogero–Moser spaces

We present a series of algorithms for computing geometric and representation-theoretic invariants of Calogero–Moser spaces and rational Cherednik algebras associated with complex reflection groups. In particular, we are concerned with Calogero–Moser families (which correspond to the mathbb {C}^times -fixed points of the Calogero–Moser space) and cellular characters (a proposed generalization by Rouquier and the first author of Lusztig’s constructible characters based on a Galois covering of the Calogero–Moser space). To compute the former, we devised an algorithm for determining generators of the center of the rational Cherednik algebra (this algorithm has several further applications), and to compute the latter we developed an algorithmic approach to the construction of cellular characters via Gaudin operators. We have implemented all our algorithms in the Cherednik Algebra Magma Package by the second author and used this to confirm open conjectures in several new cases. As an interesting application in birational geometry we are able to determine for many exceptional complex reflection groups the chamber decomposition of the movable cone of a mathbb {Q}-factorial terminalization (and thus the number of non-isomorphic relative minimal models) of the associated symplectic singularity. Making possible these computations was also a source of inspiration for the first author to propose several conjectures about the geometry of Calogero–Moser spaces (cohomology, fixed points, symplectic leaves), often in relation with the representation theory of finite reductive groups.

Motivic Atiyah-Segal Completion Theorem

Abstract Let $T$ be a torus, $X$ a smooth separated scheme of finite type equipped with a $T$-action, and $[X/T]$ the associated quotient stack. Given any localizing ${\mathbb {A}}^{1}$-homotopy invariant of dg categories $E$ (homotopy $K$-theory, algebraic $K$-theory with coefficients, étale $K$-theory with coefficients, $l$-adic algebraic $K$-theory, $l$-adic étale $K$-theory, semi-topological $K$-theory, topological $K$-theory, periodic cyclic homology, etc), we prove that the derived completion of $E([X/T])$ at the augmentation ideal $I$ of the representation ring $R(T)$ of $T$ agrees with the classical Borel construction associated to the $T$-action on $X$. Moreover, for certain localizing ${\mathbb {A}}^{1}$-homotopy invariants, we extend this result to the case of a linearly reductive group scheme $G$. As a first application, we obtain an alternative proof of Krishna’s completion theorem in algebraic $K$-theory, of Thomason’s completion theorem in étale $K$-theory with coefficients, and also of Atiyah-Segal’s completion theorem in topological $K$-theory (for those topological $M$-spaces $X^{\textrm {an}}$ arising from analytification; $M$ is a(ny) maximal compact Lie subgroup of $G^{\textrm {an}}$). These alternative proofs lead to a spectral enrichment of the corresponding completion theorems and also to the following improvements: in the case of Thomason’s completion theorem the base field $k$ no longer needs to be separably closed, and in the case of Atiyah-Segal’s completion theorem the topological $M$-space $X^{\textrm {an}}$ no longer needs to be compact and the $M$-equivariant topological $K$-theory groups of $X^{\textrm {an}}$ no longer need to be finitely generated over the representation ring $R(M)$. As a second application, we obtain new completion theorems in $l$-adic étale $K$-theory, in semi-topological $K$-theory and also in periodic cyclic homology. As a third application, we obtain a description of the different equivariant cohomology groups in the literature (motivic, $l$-adic, morphic, Betti, de Rham, etc) in terms of derived completion. Finally, in two appendixes of independent interest, we extend a result of Weibel on homotopy $K$-theory from the realm of schemes to the broad setting of quotient stacks and establish some useful properties of semi-topological $K$-theory.

The left adjoint of derived parabolic induction

We prove that the derived parabolic induction functor, defined on the unbounded derived category of smooth mod p representations of a p-adic reductive group, admits a left adjoint textrm{L}(U,-). We study the cohomology functors textrm{H}^icirc textrm{L}(U,-) in some detail and deduce that textrm{L}(U,-) preserves bounded complexes and global admissibility in the sense of Schneider–Sorensen. Using textrm{L}(U,-) we define a derived Satake homomorphism and prove that it encodes the mod p Satake homomorphisms defined explicitly by Herzig.

Premature drug reduction after subthalamic nucleus deep brain stimulation leading to worse depression in patients with Parkinson's disease

BackgroundReduction of medication in Parkinson's disease (PD) following subthalamic nucleus deep brain stimulation (STN-DBS) has been recognized, but the optimal timing for medication adjustments remains unclear, posing challenges in postoperative patient management.ObjectiveThis study aimed to provide evidence for the timing of medication reduction post-DBS using propensity score matching (PSM).MethodsIn this study, initial programming and observation sessions were conducted over 1 week for patients 4–6 weeks postoperatively. Patients were subsequently categorized into medication reduction or non-reduction groups based on their dyskinesia evaluation using the 4.2-item score from the MDS-UPDRS-IV. PSM was employed to maintain baseline comparability. Short-term motor and neuropsychiatric symptom assessments for both groups were conducted 3–6 months postoperatively.ResultsA total of 123 PD patients were included. Baseline balance in motor and non-motor scores was achieved between the two groups based on PSM. Short-term efficacy revealed a significant reduction in depression scores within the non-reduction group compared to baseline (P &amp;lt; 0.001) and a significant reduction compared to the reduction group (P = 0.037). No significant differences were observed in UPDRS-III and HAMA scores between the two groups. Within-group analysis showed improvements in motor symptoms, depression, anxiety, and subdomains in the non-reduction group, while the reduction group exhibited improvements only in motor symptoms.ConclusionThis study provides evidence for the timing of medication reduction following DBS. Our findings suggest that early maintenance of medication stability is more favorable for improving neuropsychiatric symptoms.

On the generalised Springer correspondence for groups of type 𝐸₈

We complete the determination of the generalised Springer correspondence for connected reductive algebraic groups, by proving a conjecture of Lusztig on the last open cases which occur for groups of type E 8 E_8 .

Treatment of active systemic lupus erythematosus with baricitinib: A meta-analysis of randomized controlled trials.

This study aimed to evaluate the safety and effectiveness of baricitinib in patients with systemic lupus erythematosus (SLE). We searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Register to find relevant publications. Using data from randomized controlled trials (RCTs), we performed a meta-analysis to investigate the safety and efficacy of baricitinib in patients with active SLE who did not respond well to standard treatments. A total of 1849 individuals (1235 experimental participants and 614 controls) from three RCTs on baricitinib were included. A reduction of ≥ 4 points from baseline in SLEDAI-2K score in the baricitinib 4mg group was greater than the placebo group's reduction (odds ratio [OR] = 1.407, 95% confidence interval [CI] 1.123-1.763, p = .003). The baricitinib 4mg group significantly outperformed the placebo group in terms of SLEDAI-2K remission of arthritis or rash (OR = 1.327, 95% CI = 1.059-1.663, p = .014). Other effectiveness outcomes such as the SRI4 response did not substantially improve in the baricitinib 4mg group when compared with the placebo group. And there were no significant increase in the efficacy outcomes in the baricitinib 2mg group than in the placebo group. However, there was a substantially higher incidence of severe adverse events (SAE) and serious infections in the baricitinib 4mg group (OR = 1.493, 95% CI = 1.002-2.225, p = .049; OR = 2.303, 95% CI = 1.147-4.622, p = .019) compared to the placebo group. There were no differences between the baricitinib 2mg and placebo groups in any of the safety outcome data. Meta-analysis reveals that baricitinib 4mg is beneficial for treating active SLE in terms of a reduction of ≥ 4 points from baseline in SLEDAI-2K score and SLEDAI-2K remission of arthritis or rash. However, the higher frequency of SAEs and serious infections was observed in the group receiving baricitinib 4mg.

Cellular [formula omitted]-homology and the motivic version of Matsumoto's theorem

We define a new version of A1-homology, called cellular A1-homology, for smooth schemes over a field that admit an increasing filtration by open subschemes with cohomologically trivial closed strata. We provide several explicit computations of cellular A1-homology and use them to determine the A1-fundamental group of a split reductive group over an arbitrary field, thereby obtaining the motivic version of Matsumoto's theorem on universal central extensions of split, semisimple, simply connected algebraic groups. As applications, we uniformly explain and generalize results due to Brylinski-Deligne and Esnault-Kahn-Levine-Viehweg, determine the isomorphism classes of central extensions of such an algebraic group by an arbitrary strictly A1-invariant sheaf and also reprove classical results of E. Cartan on homotopy groups of complex Lie groups.

Effects of Mediterranean diet or mindfulness-based stress reduction on fetal and neonatal brain development: a secondary analysis of a randomized clinical trial

Maternal suboptimal nutrition and high stress levels are associated with adverse fetal and infant neurodevelopment. This study aimed to investigate if structured lifestyle interventions involving a Mediterranean diet or mindfulness-based stress reduction during pregnancy are associated with differences in fetal and neonatal brain development. This was a secondary analysis of the randomized clinical trial Improving Mothers for a Better Prenatal Care Trial Barcelona that was conducted in Barcelona, Spain, from 2017 to 2020. Participants with singleton pregnancies were randomly allocated into 3 groups, namely Mediterranean diet intervention, stress reductionprogram, or usual care. Participants in the Mediterranean diet group received monthly individual sessions and free provision of extra-virgin olive oil and walnuts. Pregnant women in the stress reduction group underwent an 8-week mindfulness-based stress reduction program adapted for pregnancy. Magnetic resonance imaging of 90 fetal brains was performed at 36 to 39 weeks of gestation and the Neonatal Neurobehavioral Assessment Scale was completed for 692 newborns at 1 to 3 months. Fetal outcomes were the total brain volume and lobular or regional volumes obtained from a 3-dimensional reconstruction and semiautomatic segmentation of magnetic resonance images. Neonatal outcomes were the 6 clusters scores of the Neonatal Neurobehavioral Assessment Scale. Multiple regression analyses were conducted to assess the association between the interventions and the fetal and neonatal outcomes. When compared with the usual care group, the offspring exposed to a maternal Mediterranean diet had a larger total fetal brain volume (mean, 284.11 cm3; standard deviation, 23.92 cm3 vs 294.01 cm3; standard deviation, 26.29 cm3; P=.04), corpus callosum (mean, 1.16 cm3; standard deviation, 0.19 cm3 vs 1.26 cm3; standard deviation, 0.22 cm3; P=.03), and right frontal lobe (44.20; standard deviation, 4.09 cm3 vs 46.60; standard deviation, 4.69 cm3; P=.02) volumes based on magnetic resonance imaging measures and higher scores in the Neonatal Neurobehavioral Assessment Scale clusters of autonomic stability (mean, 7.4; standard deviation, 0.9 vs 7.6; standard deviation, 0.7; P=.04), social interaction (mean, 7.5; standard deviation, 1.5 vs 7.8; standard deviation, 1.3; P=.03), and range of state (mean, 4.3; standard deviation, 1.3 vs 4.5; standard deviation, 1.0; P=.04). When compared with the usual care group, offspring from the stress reduction group had larger fetal left anterior cingulate gyri volume (1.63; standard deviation, 0.32 m3 vs 1.79; standard deviation, 0.30 cm3; P=.03) based on magnetic resonance imaging and higher scores in the Neonatal Neurobehavioral Assessment Scale for regulation of state (mean, 6.0; standard deviation, 1.8 vs 6.5; standard deviation, 1.5; P<.01). Maternal structured lifestyle interventions involving the promotion of a Mediterranean diet or stress reduction during pregnancy were associated with changes in fetal and neonatal brain development.

Endo-laparoscopic scrotal hernia surgery: which technique must we choose to reduce seroma-sac transection or complete sac reduction? A prospective study.

Seroma formation is one of the important postoperative problems in inguinal hernia surgery, especially after scrotal hernia surgery. The present study aimed to present primarily the incidence of seroma after reduction and transection of the hernia sac in endo-laparoscopic scrotal hernia repair, and secondarily the results of early postoperative complications. Patients were divided into two groups TAPP and TEP. These groups were also divided into transection and reduction subgroups. In the reduction group, the hernia sac was completely dissected and pulled to the peritoneal area, while in the transection group, the neck of the hernia sac was cut by ligating, and its distal part was fixed to the posterior abdominal wall. The groups were compared, and data were analyzed. The reduction was performed in 13 (43.33%) of the 30 patients included in the study, and transection in 17 (56.67%). Seroma developed in 2 (15.38%) of the reduction group and 7 (41.18%) of the transection group. There was no statistical difference between the groups (p = 0.229). Cord and testicular complications were seen in 6 (20%) patients, 5 (38.46%) in the reduction group, and 1 (5.88%) in the transection group. No statistical difference was detected between the groups (p = 0.061). Although not statistically significant, seroma was more common in transection, while cord and testicular complications were more common in reduction. If dissection of the hernia sac is difficult, the complete reduction should not be insisted on, and the neck of the sac should be transection by ligating, and its distal part should be fixed to the posterior abdominal wall.

Preliminary fracture reduction in children with type III supracondylar humerus fractures during the COVID-19 pandemic.

During the COVID-19 pandemic, the time elapsed from injury to definitive surgery necessitated delay in type III pediatric supracondylar humerus fractures. Preliminary fracture reduction was recommended in these fractures while waiting for operative treatment. The purpose of this study was to evaluate whether preliminary reduction afforded a better treatment experience and improved outcomes. A retrospective cohort analysis of 161 type III supracondylar humerus fractures compared treatment with preliminary closed fracture reduction and delayed percutaneous pin placement (110 children) to delayed combined closed reduction and pin placement (51 children) in a children's medical center. Of the preliminary reduction group, 22 (20%) required analgesic pain relief, compared to 18 (35%) in the non-preliminary reduction group ( P = 0.037), and the preliminary reduction group had statistically less pain (assessed using the Faces Pain Scale-Revised rating) the first night after injury and the first-night post-CRPP ( P = 0.019, P = 0.008). Cast splitting was more frequent in the non-preliminary reduction group, 11 patients (22%) than in the preliminary reduction group, 10 patients (9%; P = 0.029). The operative times in the preliminary reduction group were shorter ( P < 0.001). If delay is necessary for complete repair of type III supracondylar humerus fractures, a preliminary fracture reduction with a temporary cast can be recommended, as these children will experience a more comfortable interval, with less swelling and pain, and potentially a shorter operation. Level of Evidence: Level III-therapeutic study.

Early treatment for benign paroxysmal positional vertigo secondary to sudden sensorineural hearing loss.

Sudden sensorineural hearing loss (SSNHL) accompanied by benign paroxysmal positional vertigo (BPPV) is relatively common in the clinic. There are unified standards for the treatment of primary BPPV with good reduction effect, while there are few studies on the treatment of BPPV secondary to SSNHL within 1 week of onset. The study was to investigate the treatment of BPPV secondary to SSNHL and compare its manual reduction with that of primary BPPV. We selected 90 patients with BPPV accompanied by SSNHL within a week of onset and 210 primary BPPV patients at Hebei Provincial Eye Hospital from June 2020 to December 2022. The former group was divided into the medicine group and manual reduction plus medicine group. The medicines used were extract of Ginkgo biloba leaves injection, betahistine hydrochloride injection and oral prednisone. We contrasted the efficacy respectively for posterior semicircular canal BPPV (psc-BPPV), horizontal semicircular canal BPPV (hsc-BPPV) and multiple semicircular canal BPPV (msc-BPPV). In addition, we compared the manual reduction effect for primary BPPV and manual reduction group, and the evaluation of efficacy are the intensity of nystagmus and the clinical symptoms. In the secondary BPPV group, there was no difference in efficacy between the medicine group and manual reduction group at the 7th-day after reduction for psc-BPPV, hsc-BPPV, and msc-BPPV (P > .05). The immediate effect of reduction was significantly different between the primary BPPV group and the group with SSNHL and BPPV for both psc-BPPV and hsc-BPPV (P < .05), and the effect of the primary BPPV group was better, but it was no difference for msc-BPPV (P > .05). For the treatment of BPPV accompanied by SSNHL within 1 week of onset, the additional reduction therapy showed no benefit, so we need to apply medication for SSNHL.

Representation ring of Levi subgroups versus cohomology ring of flag varieties III

For any reductive group G and a parabolic subgroup P with its Levi subgroup L, the first author [9] introduced a ring homomorphism ξλP:Repλ−polyC(L)→H⁎(G/P,C), where Repλ−polyC(L) is a certain subring of the complexified representation ring of L (depending upon the choice of an irreducible representation V(λ) of G with highest weight λ). In this paper we study this homomorphism for G=SO(2n) and its maximal parabolic subgroups Pn−k for any 2≤k≤n−1 (with the choice of V(λ) to be the defining representation V(ω1) in C2n). Thus, we obtain a C-algebra homomorphism ξn,kD:Repω1−polyC(SO(2k))→H⁎(OG(n−k,2n),C). We determine this homomorphism explicitly in the paper. We further analyze the behavior of ξn,kD when n tends to ∞ keeping k fixed and show that ξn,k becomes injective in the limit. We also determine explicitly (via some computer calculation) the homomorphism ξλP for all the exceptional groups G (with a specific ‘minimal’ choice of λ) and all their maximal parabolic subgroups except E8.

Hydroxychloroquine is effective in oral lichen planus: A multicenter, randomized, controlled trial.

This study was aimed to evaluate the safety and benefit of short-term application of hydroxychloroquine in the management of atrophic/erosive/ulcerative oral lichen planus (OLP). This multicenter, randomized, controlled, evaluator-blinded, prospective clinical trial was performed from October 1, 2019, to September 1, 2022. A total of 99 patients were randomized to receive systemic use of hydroxychloroquine (n = 50), or topical use of 0.05% dexamethasone (n = 49) for 4 weeks. The response to both treatment modalities was evaluated according to reticulation, hyperemic, and ulceration (RHU) score and visual analog scale (VAS) score. After 4 weeks of medication, both groups showed substantial reduction in RHU and VAS score (p < 0.05). In hydroxychloroquine group, the average of RHU score was reduced from 10.60 to 7.68 (dropped 27.49%), and the average of VAS score was reduced from 3.74 to 2.47 (dropped 34.09%). There were no differences between the two groups in reduction of RHU score and VAS score (p > 0.05). Single factor analysis found hyperemic area (p = 0.019) and erosive/ulcerative area (p = 0.024) had impacts on drug efficacy of hydroxychloroquine, and logistic regression revealed that no factors (p > 0.05) influenced its efficacy. These findings indicate hydroxychloroquine is a safe and effective agent in treating atrophic/erosive/ulcerative OLP.

The degree of fracture reduction does not compromise the clinical efficacy of arthroscopic reduction and fixation of tibial posterior cruciate ligament avulsion fractures: A retrospective study.

This study aimed to explore the postoperative outcomes of patients who underwent arthroscopic internal fixation with repositioning sutures for the treatment of posterior cruciate ligament (PCL) avulsion fractures with poorly reduced fracture fragments. It was hypothesized that improperly repositioned fracture fragments might not influence the postoperative clinical outcomes in patients with PCL avulsion fractures treated by arthroscopic sutures. From January 2020 to December 2021, patients admitted to our hospital with PCL avulsion fractures were evaluated. Our inclusion criteria were as follows: diagnosis of PCL avulsion fracture as Meyers & McKeever Type II or Type III; underwent arthroscopic double tunnel suture fixation; and age below 70. Of the patients meeting these criteria, data from 34 individuals were collected by a designated follow-up officer. Based on postoperative imaging, the patients were divided into 2 groups: well fracture reduction and poor fracture reduction groups. Prior to the surgery, the Lysholm score, knee mobility, and international knee documentation committee (IKDC score) were recorded for both groups. At the 3-month post-surgery mark, CT-3D reconstruction was performed. Statistical analysis was conducted on the collected data. For data that conformed to a normal distribution, the t test was applied. For data that didn't conform, we used a non-parametric test. Both groups achieved successful wound healing without encountering any adverse events, such as fracture nonunion infection. Fracture healing was observed in both groups at the 3-month postoperative mark. The average follow-up duration was 13.24 ± 6.18 months. There were no significant differences in Lysholm score, IKDC score, or knee mobility between the well- and poorly-reduced groups at the final follow-up (P > .05). Postoperatively, both groups demonstrated significant improvements in knee function compared to the preoperative scores, with statistically significant differences observed in Lysholm score, IKDC score, and knee mobility (P < .05). Arthroscopic fixation with double-tunnel sutures proved to be a highly effective treatment approach for PCL avulsion fractures, even in cases where the fractures were poorly reduced. Remarkably, there were no significant differences observed in postoperative knee function between the well- and poorly-reduced groups, indicating that both groups achieved favorable outcomes.

Antipsychotic dose reduction and discontinuation versus maintenance treatment in people with schizophrenia and other recurrent psychotic disorders in England (the RADAR trial): an open, parallel-group, randomised controlled trial

Maintenance antipsychotic medication is recommended for people with schizophrenia or recurrent psychosis, but the adverse effects are burdensome, and evidence on long-term outcomes is sparse. We aimed to assess the benefits and harms of a gradual process of antipsychotic reduction compared with maintenance treatment. Our hypothesis was that antipsychotic reduction would improve social functioning with a short-term increase in relapse. RADAR was an open, parallel-group, randomised trial done in 19 National Health Service Trusts in England. Participants were aged 18 years and older, had a diagnosis of recurrent, non-affective psychotic disorder, and were prescribed an antipsychotic. Exclusion criteria included people who had a mental health crisis or hospital admission in the past month, were considered to pose a serious risk to themselves or others by a treating clinician, or were mandated to take antipsychotic medication under the Mental Health Act. Through an independent, internet-based system, participants were randomly assigned (1:1) to gradual, flexible antipsychotic reduction, overseen by treating clinicians, or to maintenance. Participants and clinicians were aware of treatment allocations, but assessors were masked to them. Follow-up was for 2 years. Social functioning, assessed by the Social Functioning Scale, was the primary outcome. The principal secondary outcome was severe relapse, defined as requiring admission to hospital. Analysis was done blind to group identity using intention-to-treat data. The trial is completed and has been registered with ISRCTN registry (ISRCTN90298520) and with ClinicalTrials.gov (NCT03559426). 4157 people were screened, of whom 253 were randomly allocated, including 168 (66%) men, 82 (32%) women, and 3 (1%) transgender people, with a mean age of 46 years (SD 12, range 22-79). 171 (67%) participants were White, 52 (21%) were Black, 16 (6%) were Asian, and 12 (5%) were of other ethnicity. The median dose reduction at any point during the trial was 67% in the reduction group and zero in the maintenance group; at 24 months it was 33% versus zero. At the 24-month follow-up, we assessed 90 of 126 people assigned to the antipsychotic dose reduction group and 94 of 127 assigned to the maintenance group, finding no difference in the Social Functioning Scale (β 0·19, 95% CI -1·94 to 2·33; p=0·86). There were 93 serious adverse events in the reduction group affecting 49 individuals, mainly comprising admission for a mental health relapse, and 64 in the maintenance group, relating to 29 individuals. At 2-year follow-up, a gradual, supported process of antipsychotic dose reduction had no effect on social functioning. Our data can help to inform decisions about the use of long-term antipsychotic medication. National Institute for Health Research.

Effects of different sponge implantation methods of negative pressure wound therapy on wound healing of deep surgical site infection after spinal surgery.

After spinal surgery, negative pressure wound treatment (NPWT) improves deep surgical site infection (DSSI) wound healing. This research compared the healing benefits of two sponge implantation strategies in NPWT for DSSI. 21 patients with DSSI utilized NPWT to improve wound healing following spine surgery were followed from January 1, 2012 to December 31, 2021. After antibiotic treatment failure, all these patients with DSSI received extensive debridement and NPWT. They are grouped by sponge placement method: centripetal reduction and segment reduction. The two groups' hospital stays, NPWT replacement frequency, wound healing time, healing speed, and quality of wound healing (POSAS score) were compared. All patients had been cured by the end of December 2022, and the mean follow-up time was 57.48 ± 29.6 months. Surgical incision length did not vary across groups (15.75±7.61 vs. 15.46±7.38 cm, P = 0.747). The segmental reduction approach had shorter hospital stay and NPWT treatment times than the centripetal reduction method (39.25±16.04 vs. 77.38±37.24 days, P = 0.027). Although there is no statistically significant difference, the mean wound healing duration of segmental reduction group is faster than that of centripetal reduction group (0.82±0.39 vs 0.45±0.28 cm/d, P = 0.238), wound healing quality (POSAS) (33.54±8.63 vs 48.13±12.17, P = 0.408) is better in segmental reduction group, and NPWT replacement frequency (2.62 ± 1.04 vs 3.88 ± 1.25, P < .915) is smaller in segmental reduction group. NPWT heals wounds and controls infection. Segmental reduction method accelerates wound healing, reduces hospital stay, and improves wound quality compared to central reduction method.