Clinical Follow-up Results Research Articles

Sulcus-Deepening Trochleoplasty and Medial Patellofemoral Ligament Reconstruction Provide Good Clinical Outcomes in Addressing Patellar Instability at Mid-Term Follow-Up: A Retrospective Case Series.

To update previously published clinical and radiographic outcomes of Dejour sulcus-deepening trochleoplasty and medial patellofemoral ligament reconstruction (MPFL-R), at mid-term follow-up, and monitor trends in patient reported outcome scores and satisfaction. Using the same cohort of patients from our previously published short-term series of 2-year follow up, interval follow-up was performed on 67 patients (76 knees) with severe trochlear dysplasia and recurrent patellar instability who were prospectively enrolled and underwent Dejour sulcus-deepening trochleoplasty and MPFL-R combined with other patellar-stabilization procedures. Patients with less than 2-year follow-up were excluded. Evaluation involved radiographic analysis, physical examination, clinical follow-up, and patient-reported outcome scores. 37 patients (45 knees) were included in the current study, with mean follow-up of 6.1 years postoperatively (Standard deviation [SD] 2.7 years). Two interval re-operations were performed (arthroscopic lysis of adhesions; hardware removal and arthroscopic shaving chondroplasty). There remained no occurrences of re-operation for recurrent patellar instability. Patient reported outcomes were largely stable from early (mean 3.6 years) to mid-term (mean 6.1 years) follow up with no statistically significant difference between early and mid-term International Knee Documentation Committee (IKDC) (P = 0.75), Kujala (P = 0.47) or VAS (Visual analog scale) pain (P = 0.06) scores. Compared to preoperative knee scores, there was a significant difference in IKDC (49.3 vs 82.0, P < 0.001, d = 1.85), Kujala (56.5 vs 89.3, P < 0.001, d = 2.03), and VAS pain (3.8 vs 1.9, P = 0.003, d = 0.33) scores at mid-term follow up (mean 6.1 years). Mean Kellgren-Lawrence grading of patellofemoral arthritis showed no statistically significant change from 0.56 to 0.52 (P = 0.511) on sunrise radiographs at the most recent follow-up. At mid-term follow-up, Dejour sulcus-deepening trochleoplasty and MPFL-R, combined with other patellar stabilization procedures, achieves durable resolution of patellar instability with maintained patient-reported outcome scores and satisfaction rates, and is without interval evidence of clinical or radiographic progression of patellofemoral arthritis. IV, Case Series.

Comparison of Synovialization and Clinical Outcomes between Anterior Cruciate Ligament Anteromedial Bundle Augmentation and Double-Bundle Anterior Cruciate Ligament Reconstruction.

This study aimed to compare clinical outcomes and second-look arthroscopic findings between double-bundle anterior cruciate ligament (ACL) reconstruction for complete ACL rupture and anteromedial (AM) bundle augmentation with preservation of the posterolateral (PL) bundle in isolated AM bundle rupture. Between 2014 and 2021, we retrospectively analyzed 95 ACL reconstructions with at least 2 years of follow-up. Patients undergoing primary ACL reconstruction from January 2014 to June 2021 were included in the study. Double-bundle ACL reconstruction (group 1) was performed in the cases involving male patients, high activity levels, age below 40 years, or when there was a patient preference for double-bundle reconstruction. In contrast, for partial ACL ruptures with an intact PL bundle confirmed on preoperative magnetic resonance imaging, AM augmentation was performed (group 2). Preoperative and final follow-up clinical outcomes, along with synovial coverage during second-look arthroscopy, were compared between group 1 (65 cases) and group 2 (30 cases). Statistical analysis included correlation coefficients between the groups. The Lysholm score, Tegner activity scores, and International Knee Documentation Committee (IKDC) knee evaluation form score at final follow-up were 81.8 (±5.5), 7.2 (±0.9), and 79.4 (±6.7), respectively, in group 1, and they were 88.0 (±6.4, p = 0.038), 7.9 (±0.5, p = 0.042), and 86.2 (±5.4, p = 0.081), respectively, in group 2. For group 1, the Lachman test (p = 0.093) and the pivot shift test (p = 0.176) at the final follow-up showed no laxity in 57 and 59 knees, and there was plus one laxity in 8 and 6 knees. For group 2, there were no laxity in 27 and 28 knees, and plus one laxity in 3 and 2 knees. Synovial coverage area percentages of the grafted tendon were 74.3 (±10.7) and 86.9 (±7.3, p = 0.002) in groups and group 2, respectively, with superior synovial coverage observed in group 2. The AM bundle augmentation with preservation of the PL bundle in ACL injury yielded better synovial coverage and clinical scores compared with double-bundle ACL reconstruction for complete ACL rupture.

Flow-diverting stents in the management of extracranial carotid artery aneurysms.

This study aims to investigate the indications and therapeutic efficacy of flow-diverting stents (FDSs) in the management of extracranial carotid artery aneurysms (ECAAs) and dissections. A retrospective analysis was conducted on 18 patients treated for ECAAs with an FDS between 2010 and 2024. Patient demographics, aneurysm characteristics, procedural details, and clinical and radiologic follow-up outcomes were extracted from medical records. Procedures were performed under general anesthesia using standard endovascular techniques. Patients received preoperative and postoperative antiplatelet therapy and were fully anticoagulated during the procedure. Follow- up assessments included digital subtraction angiography or computed tomography angiography at 6-12 months and clinical evaluations to monitor symptom resolution and complications. Eighteen patients, with an average age of 46.44 ± 17.54 years, underwent 19 endovascular interventions. Technical success was achieved in all cases. Single stent deployment was used in 15 aneurysms, and telescopic stent deployment in 7. Total occlusion of the aneurysm was achieved in 94.4% of cases. One patient required retreatment due to the separation of two overlapped telescopic stents. All patients were discharged within 2 days post-procedure, with symptomatic patients experiencing the complete resolution of symptoms. No complications or adverse events were reported during the follow-up period. The endovascular treatment of ECAAs with FDSs appears to be a safe and effective alternative, achieving high technical success and positive clinical outcomes. The use of FDSs for treating ECAAs significantly improves patient outcomes with minimal complications.

Results of carotid stenting in patients with contralateral internal carotid artery occlusion: a retrospective single-center analysis and 22 years of experience.

Patients with contralateral carotid artery occlusion (CCO) represent a subgroup of patients at risk for revascularization procedures. The choice of appropriate revascularization procedure (carotid endarterectomy (CEA) or carotid artery stenting (CAS)) in these patients is controversial. The aim of this study is to share the results of clinical and radiological follow-up after CAS in these patients and to contribute to the literature by evaluating the efficacy and safety of stenting. In our study, the clinical and radiological data of 145 patients with CCO and 145 age-gender-matched patients without CCO who underwent elective CAS in the interventional neuroradiology clinic between 2001 and 2023 were retrospectively analyzed. A comparison was made between short- and long-term outcomes between the two groups. The overall technical success rate of CAS was 99.7% and the 30-day all-cause mortality rate was 1.4%. There was no statistically significant difference between the two groups in terms of early-term (intra-procedural thromboembolic events, post-procedural symptomatic hyperperfusion, intraparenchymal hemorrhage, major and minor ischemic stroke, early-term mortality rate) and long-term (intimal hyperplasia, residual stenosis, major and minor ischemic stroke and long-term all-cause mortality rate) (p > 0.05). In our experience, it was concluded that CAS performed by an experienced interventional neuroradiology team in patients with CCO does not pose an additional risk. Since CCO poses a risk for CAE, CAS may be a more acceptable treatment modality in these patients due to less perioperative risk. However, further research is required to support our findings.

Reconstructive endovascular treatment of patients with ruptured distal intracranial aneurysms in posterior circulation: a retrospective cohort study.

Cases of ruptured distal intracranial aneurysms (DIAs) in the posterior circulation are rare. Currently, the most commonly used approach in clinical practice to treat this condition is reconstructive endovascular treatment. However, research on endovascular treatment of intracranial posterior circulation ruptured DIAs is currently lacking. This study aimed to analyze the safety and efficacy of reconstructive endovascular treatment for DIAs in the posterior circulation. A retrospective cohort study was conducted on patients with ruptured distal posterior circulation aneurysms who underwent endovascular reconstructive treatment at The First Affiliated Hospital of Harbin Medical University from September 2014 to August 2023. We collected and analyzed the patients' characteristics, clinical outcomes, and angiographic follow-up results. Complications were determined and recorded based on the patients' hospital records and imaging examination results. Clinical information was collected through neurological assessments and follow-up telephone interviews. Follow-up angiographic evaluations using digital subtraction angiography (DSA) were planned for 6 months after the procedure until 1-year postprocedure. The procedure was successfully performed on all 49 patients. Among the patients, 16 (32.7%) were males. The mean age of all patients was 59.0±12.7 years. A total of 15 (30.6%) patients used stent-assisted coiling. During hospitalization, 16 (32.7%) patients experienced complications, including 6 with hemorrhagic complications, 7 with ischemic complications, and 4 with shunt-dependent hydrocephalus. One patient had both shunt-dependent hydrocephalus and ischemic complications. Three (6.1%) patients died during hospitalization, all related to aneurysm rebleeding. All patients underwent clinical follow-up, with a median follow-up time of 39 months [interquartile range (IQR), 21.0-70.5 months]. At the last follow-up, 42 (85.7%) patients had a modified Rankin scale score of 0-2. During the follow-up period, one patient died, resulting in an overall mortality rate of 8.2% (4/49). A total of 35 surviving patients underwent angiographic follow-up, with a follow-up rate of 76.1% (35/46) and a median follow-up time of 8.5 months (IQR, 6.0-12.0 months). Among the follow-up patients, 94.3% were classified as Raymond-Roy grade 1-2, and two patients experienced residual aneurysm. Survival analysis showed a 1-year complication-free survival rate of 69.4% and a 1-year overall survival rate of 89.3%. This study found that the incidence of complications during hospitalization was relatively high. However, the clinical follow-up results were satisfactory, and imaging follow-up demonstrated a high aneurysm occlusion rate. In summary, endovascular treatment of ruptured DIAs in the posterior circulation is feasible, safe, and effective, but attention should still be paid to the occurrence of related complications.

Robot-assisted radical nephroureterectomy using the KangDuo Surgical Robot-01 System versus the da Vinci System: a multicenter prospective randomized controlled trial.

We aim to compare the safety and effectiveness of the KangDuo (KD)-Surgical Robot-01 (KD-SR-01) system and the da Vinci (DV) system for robot-assisted radical nephroureterectomy (RARNU). This multicenter prospective randomized controlled trial was conducted between March 2022 and September 2023. Group 1 included 29 patients undergoing KD-RARNU. Group 2 included 29 patients undergoing DV-RARNU. Patient demographic and clinical characteristics, perioperative data, and follow-up outcomes were collected prospectively and compared between the two groups. There were no significant differences in patient baseline demographic and preoperative characteristics between the two groups. The success rates in both groups were 100% without conversion to open or laparoscopic surgery or positive surgical margins. No significant difference was observed in docking time [242 (120-951) s vs 253 (62-498) s, P = 0.780], console time [137 (55-290) min vs 105 (62-220) min, P = 0.114], operative time [207 (121-460) min vs 185 (96-305) min, P = 0.091], EBL [50 (10-600) mL vs 50 (10-700) mL, P = 0.507], National Aeronautics and Space Administration Task Load Index scores, and postoperative serum creatinine levels between the two groups. None of the patients showed evidence of distant metastasis, local recurrence, or equipment-related adverse events during the four-week follow-up. One (3.4%) patient in Group 2 experienced postoperative enterovaginal and enterovesical fistulas (Clavien-Dindo grade III). The KD-SR-01 system is safe and effective for RARNU compared to the DV Si or Xi system. Further randomized controlled studies with larger sample sizes and longer durations are required.

The relation of anti-phosphatidylserine/prothrombin antibodies and premature rupture of membranes: A retrospective cohort study.

Existing literature supports the association between atypical phospholipid antibodies - anti-phosphatidylserine/prothrombin antibodies (aPS/PT) and adverse pregnancy outcomes. This study aimed to investigate the relationship between aPS/PT and premature rupture of membranes (PROM). A retrospective cohort study analysis was conducted on 408 pregnant women who had experienced at least one unexplained miscarriage. They were tested for aPS/PT IgM and IgG, and clinical data, test results, and follow-up pregnancy outcomes were collected. A positive correlation was observed between aPS/PT IgM or IgG and PROM in both single-factor and multi-factor regression analysis. After adjusting for potential confounders, the odds ratio (OR) values for aPS/PT IgM and aPS/PT IgG were 1.03 (95 % CI: 1-1.05, P = 0.025) and 1.03 (95 % CI: 1.01-1.06, P = 0.016) respectively. When aPS/PT was divided in three groups, djusted OR values for aPS/PT IgG of the third tertiles compared to the first tertiles (were 2.11(95 % CI: 1.11-4, P = 0.022). Subgroup analysis supported these findings. Curve fitting revealed a linear relationship between aPS/PT IgM and aPS/PT IgG with PROM. This study suggests that aPS/PT IgG and aPS/PT IgM are independent risk factors for premature rupture of membranes, with aPS/PT IgG showing a higher significance compared to aPS/PT IgM.

Nationwide Incidence Trends of Pediatric Parotid Malignancy in Korea and a Retrospective Analysis of Single-Institution Surgical Experience of Parotidectomy

Background/Objectives: Pediatric parotid malignancies are rare but represent a critical subset of head and neck cancers. This study integrates nationwide incidence trends in Korea with detailed surgical outcomes from a single tertiary institution to better understand the characteristics and management of these tumors.Materials &amp; Methods: Nationwide data from the Korea Central Cancer Registry (1999-2019) were analyzed to assess trends in pediatric parotid malignancy incidence. A retrospective review was conducted on 31 pediatric parotidectomy cases at a tertiary hospital from 2011 to 2024. Clinical data, surgical methods, pathology results, and follow-up outcomes were examined.Results: Nationwide analysis revealed an annual mean of 9.0 ± 4.0 cases of pediatric parotid malignancies, with a significant rise in incidence among patients aged 10-19 years (APC 5.4%, 95% CI 1.1-9.8, &lt;i&gt;p&lt;/i&gt;=0.016). Institutional data showed that the median age of patients underwent parotidectomy was 15.0 years, with males comprising 67.7%. Among 31 cases, 19 (61.3%) were benign, primarily pleomorphic adenomas (68.4%), and 12 (38.7%) were malignant, predominantly mucoepidermoid carcinoma (87.5%). Superficial or partial parotidectomy was the most common surgical approach (71.0%), and no unexpected complications or recurrences were observed.Conclusion: Pediatric parotid malignancies in Korea exhibit rising incidence rates, particularly among teenagers. Surgical outcomes confirm the predominance of pleomorphic adenomas and mucoepidermoid carcinomas. Pediatric parotid surgery is a procedure with minimized complications and a promising prognosis. Tailored treatment strategies adapted to the unique characteristics of pediatric patients are essential to optimize outcomes.

Long-term Effectiveness of Amoxicillin Prophylaxis for Children with Primary Vesicoureteral Reflux

Aim: The use of antibiotic prophylaxis in the conservative treatment of vesicoureteral reflux (VUR) has a long historical precedent. In this study, we investigated the long-term efficacy of amoxicillin as antibiotic prophylaxis. Materials and Methods: A retrospective investigation was conducted to examine the clinical characteristics and follow-up results of patients with VUR who received amoxicillin prophylaxis for at least of six months. Results: A total of 44 patients were included in the study, comprising 13 girls (29.5%) and 31 boys (70.5%), with a mean age of 2.9±1.3 months. During a mean follow-up period of 27.4±19.4 months, nine patients (20.5%) experienced one urinary tract infection (UTI), while two patients (4.5%) had a febrile UTI. Antibiotic revision was performed in a total of four patients (9%), including two patients with a febrile UTI and two patients with gastrointestinal side effects. Conclusion: The long-term follow-up of patients with VUR who have been treated with amoxicillin prophylaxis has demonstrated that this is an effective and safe treatment option.

Diagnostic performance of fluorine-18-fluorodeoxyglucose PET/MRI for detection of disease recurrence in differentiated thyroid cancer: a compartment-based analysis.

The objective of this study is to evaluate the diagnostic performance of neck fluorodeoxyglucose (FDG) PET/MRI in addition to whole-body PET/computed tomography (CT) and to compare it with MRI in the detection of suspicion of disease relapse in patients with differentiated thyroid cancer (DTC) who underwent total thyroidectomy and radioactive iodine therapy. Twenty-nine patients with DTC who underwent whole-body 18F-FDG PET/CT followed by neck PET/MRI because of increased serum thyroglobulin (Tg) or anti-Tg antibody levels and negative 131I whole-body scan were included. At least 6 months of clinical and radiological (neck ultrasound) follow-up or histopathological examination results were accepted as the gold standard. Lesion and compartment-based analyses were performed to evaluate the diagnostic performances of PET/CT, MRI, and PET/MRI. In addition, changes of clinical management were evaluated. On lesion-based analysis, for PET/CT, MRI, and PET/MRI: sensitivity: 33.3, 33.3, and 37%; specificity: 90.1, 87.9, and 95.9%; accuracy: 87.5, 85.4, and 93.2 were calculated, respectively. Specificity of PET/MRI was significantly superior to PET/CT and MRI (P of0.001); however, sensitivity of PET/MRI was not significant to PET/CT and MRI (P of0.05). On compartment-based analysis, specificity of PET/MRI and MRI were comparable but significantly superior to PET/CT at levels 1 and 2; however, specificity of PET/CT and PET/MRI were comparable but significantly superior than MRI, especially at levels 3, 4, and 5. PET/MRI especially helps in the accurate exclusion of findings that are suspicious on PET/CT and MRI, and has the potential to change the clinical management by identifying uncertain neck findings.

Postoperative peritumoral edema is correlated with the prognosis in intracranial meningioma with preoperative peritumoral edema.

Preoperative peritumoral edema (PTE) in intracranial meningiomas is known to be a risk factor for postoperative recurrence. However, there are two groups: those in which preoperative PTE remains and those in which preoperative PTE receded after tumor removal. We aimed to investigate whether postoperative PTE could improve the prediction of prognosis of meningioma with preoperative PTE. We retrospectively reviewed postoperative MRI scans in 3 months after operation of 371 patients with preoperative PTE of meningioma that underwent surgery between 2015 and 2017. All the patients were classified into two different groups according to whether had postoperative PTE receded within 3 months after operation. Clinical manifestations, histopathology characteristics, radiology data and follow-up outcomes were noted. student's t-test and chi-square test for independence were used to compare clinical characteristics. Univariate and multivariate Cox analysis and Kaplan‒Meier methods were utilized to determine the independent effect of postoperative PTE on postoperative recurrence. Multivariate Cox analyses showed that the risk factors of meningioma recurrence: high WHO grades (HR = 4.989, P<0.001), superior sagittal sinus invasion (HR = 2.290, P = 0.047), postoperative PTE in 3 months after operation (HR = 1.804, P = 0.044) and STR (HR = 3.940, P = 0.003). Kaplan-Meier model showed that the progression-free survival of patients with postoperative PTE are shorter than who with postoperative PTE receded in 3 months after operation (HR = 3.30, P = 0.006). According to our research, we found that postoperative PTE in 3 months after operation is related to the outcomes of meningioma with preoperative PTE. Besides, we demonstrated that there were also some factors for recurrence: male, high WHO grades, superior sagittal sinus invasion and STR. These findings highlight the need for prospective study.

Immediate consecutive microvascular decompression for bilateral classical trigeminal neuralgia.

Classical trigeminal neuralgia (TN) is characterized by sudden, severe facial pain, typically resulting from a neurovascular conflict affecting the trigeminal nerve. In rare cases, both nerves are affected simultaneously causing bilateral TN (BTN), increasing the complexity of the treatment. Microvascular decompression (MVD) is a well-established treatment for TN; however, the experience with immediate consecutive bilateral MVD procedures is limited and requires further evaluation. To evaluate the safety and efficacy of immediate consecutive bilateral MVD in patients with severe BTN compared to non-consecutive bilateral MVD procedures. A retrospective analysis was conducted on 15 patients with BTN who underwent bilateral MVD. The data on clinical presentation, surgical technique, perioperative findings, complications, and follow-up outcomes of three cases of BTN treated with consecutive bilateral MVD surgeries were analyzed and compared to 12 who received separated procedures. Moreover, a detailed presentation of the three cases of consecutive MVD is provided to illustrate clinical decision-making, surgical nuances, and individual outcomes. Both groups achieved significant pain relief (p < 0.001) without notable differences in Barrow Neurological Institute (BNI) pain intensity score (p = 0.305), indicating that both approaches were equally effective. The consecutive MVD group experienced a shorter total surgical duration (p = 0.025), while postoperative complications were comparable (p = 0.077), mostly transient with no major adverse events or mortality. At the last follow-up, the patients remained pain-free without recurrence of TN symptoms. Consecutive bilateral MVD is a safe and effective option, comparable to non-consecutive procedures for treating BTN. This approach provides a viable alternative for patients with severe bilateral symptoms or when medical constraints limit the possibility of two separate surgeries. Further studies with larger cohorts and extended follow-up periods are needed to support these results.

A new clinical classification of congenital biliary dilatation - HUAXI CBD classification.

Current biliary dilatation (BD) classifications are complex and based on cases including secondary BD, leading to unclear distinctions. Notably, congenital and secondary BD differ in etiology, symptoms, and prognosis. To propose a more concise and more suitable classification of congenital biliary dilatation (CBD), and exploring the feasibility and effectiveness of this classification in diagnosis and treatment. Based on the preoperative imaging data of patients with CBD admitted to the Department of Pediatric Surgery of West China Hospital of Sichuan University, from January 2015 to December 2018, a new classification of CBD was accomplished according to the site of bile duct dilatation lesions, which was named HUAXI CBD classification. The CBD was classified into 4 types: type I (distal extra-hepatic bile duct dilatation), type II (distal extra-hepatic combined with right and left primary hepatic bile duct dilatation), type III (extra-hepatic combined with secondary and above hepatic bile duct dilatation), and type IV (intra-hepatic bile duct dilatation). Meanwhile, the feasibility and reliability of the HUAXI CBD classification were analyzed by analyzing the clinical treatment strategies, perioperative complications and long-term follow-up results of different subtypes. A total of 300 patients with CBD were included in this study. According to the HUAXI CBD classification method, 240 cases were type I, 48 cases were type II, 10 cases were type III, and 2 cases were type IV. After treatment, patients with type I had a normal hepatobiliary function after surgery and a good prognosis; patients with type II had good recovery of liver function in 37 cases (77.1%), but 11 cases (22.9%) had postoperative complications during follow-up; patients with type III and IV had high incidence of cholangitis (6/10, 2/2, respectively) and choledocholithiasis (5/10, 2/2, respectively) after surgery, especially those with diffuse intrahepatic dilatation having a poor prognosis, eventually developing cirrhosis and necessitating liver transplantation. The HUAXI CBD classification is consistent with treatment principles, concise and easy to remember, and more suitable for CBD clinical application.

The impact of supraspinatus tear on subscapularis muscle atrophy and fatty infiltration.

Aimed to report the prevalence and predisposing factors affecting subscapularis muscle atrophy and fatty infiltration (MAFI) in patients without a subscapularis tear, and to analyze the effect of this condition on surgical outcomes. Between 2020 and 2022, 153 patients (mean age 58.1 ± 10.2 years; 84 men and 69 women) who underwent repair of posterosuperior cuff tears, with no subscapularis tears identified during arthroscopy were retrospectively analyzed. Baseline characteristics, preoperative and follow-up (6 months) magnetic resonance imaging findings, arthroscopic findings, and clinical outcomes (>1 year) were recorded. The prevalence of subscapularis MAFI (Goutallier grade 1 or 2) was 73.9% (113/153), of which the prevalence of Goutallier grade 2 was 23.5% (36/153). From multivariable logistic regression analysis, female sex (odds ratio [OR], 5.6; 95% CI, 1.7-18.6; P=0.005), older age (OR, 1.1; 95% CI, 1.0-1.1; P=0.052), advanced supraspinatus MAFI by Goutallier grade (OR, 3.2; 95% CI, 1.5-6.9; P=0.004), and synovitis (OR, 2.8; 95% CI, 1.1-7.9; P=0.030) were identified as independent predisposing factors for subscapularis MAFI. However, patients with preoperative subscapularis MAFI exhibited similar final range of motion, pain and function, and belly press strength compared to those without preoperative subscapularis MAFI. Subscapularis MAFI is frequently observed conditions even in the absence of subscapularis tears, and this condition could be affected by supraspinatus MAFI, female sex, older age, and synovitis. However, because subscapularis MAFI does not affect the surgical outcome, surgeons need not be concerned about this condition when repairing posterosuperior rotator cuff tear. Level of evidence: IV.

Treatment of Pink Pulseless Hand Following Supracondylar Fractures of the Humerus in Children.

Background: Supracondylar humerus fractures (SCHF) in children are common and can lead to serious complications, including neurovascular injury. The optimal management of children with a 'pink pulseless' hand following such a fracture is unclear. This study aimed to ascertain an appropriate therapeutic approach for children with SCHF and a pink pulseless hand. Methods: A retrospective analysis of medical records from paediatric patients under 16 years old with SCHF and clinically perfused but pulseless hands between 1 January 2016 and 30 June 2021 was conducted. Clinical characteristics, imaging, treatment processes and follow-up results were analysed to predict arterial injuries requiring vascular repair and determine the optimal timing for exploratory surgery. Results: The study included 88 patients, predominantly male (58%) with an average age of 6 years. Most fractures resulted from falls onto outstretched arms. Satisfactory outcomes, indicated by the return of the pulse following closed reduction and percutaneous pinning (CRPP) alone, were seen in 66% of patients, negating the necessity for vascular exploration. Amongst patients with a persistently absent radial pulse 72 hours after CRPP, 83% were diagnosed with brachial artery injuries, with all such patients experiencing recurrent pulse loss after surgery. Conclusions: Urgent reduction and CRPP are effective initial treatments for children with SCHF and a pink pulseless hand. Immediate vascular exploration is generally not necessary in these patients. Further research is needed to determine the optimal management for persistent pulselessness and recurrent pulse loss. Level of Evidence: Level IV (Therapeutic).

A head-to-head comparison of [68Ga]Ga-DOTA-FGFR1 and [18F]FDG PET/CT in the diagnosis of lung cancer.

This study aimed to compare the diagnostic value of [68Ga]Ga-DOTA-FGFR1 and [18F]FDG PET/CT in the evaluation of lung cancer patients. A prospective study was conducted between March 2023 and July 2023. Patients with high clinical suspicion of lung cancer were recruited. Each participant underwent PET/CT scanning using [68Ga]Ga-DOTA-FGFR1 and [18F]FDG within 6 days. Histopathology and clinical follow-up results serve as reference criteria for final diagnosis. We used a paired samples t-test or a Wilcoxon signed-rank test to compare the uptake of [68Ga]Ga-DOTA-FGFR1 and [18F]FDG. The diagnostic performance between the two tracers was compared using the McNemar χ² test. A total of 101 participants were included (mean age 63.267 ± 9.344 [range 39-86 years]). In benign lung lesions, [68Ga]Ga-DOTA-FGFR1 had lower TBR and SUVmax than [18F]FDG (2.924 vs. 5.705, P < 0.001;1.395 vs. 4.014, P < 0.001). The TBR of [68Ga]Ga-DOTA-FGFR1 in benign lymph nodes was also lower than [18F]FDG (0.880 vs. 1.25, P < 0.001). [68Ga]Ga-DOTA-FGFR1 had a higher diagnostic specificity for primary tumors than [18F]FDG (52% vs. 28%, P = 0.031). The specificity, accuracy, and PPV of [68Ga]Ga-DOTA-FGFR1 for detecting lymph node metastasis were 82.54%, 78.66%, and 53.73%, respectively, higher than that of [18F]FDG (53.80%, P < 0.001, 63.15%, P < 0.001 and 38.35%, P = 0.003). However, its sensitivity in the diagnosis of lymph node and distant metastasis was not as good as [18F]FDG PET/CT (P < 0.001, P = 0.016, respectively). There was a significant correlation between [68Ga]Ga-DOTA-FGFR1 uptake and FGFR1 expression (Spearman r = 0.6901, p < 0.0001). [68Ga]Ga-DOTA-FGFR1 PET/CT had higher specificity than [18F]FDG PET/CT for the detection of primary lung cancer. In addition, [68Ga]Ga-DOTA-FGFR1 PET/CT also had higher diagnostic accuracy, specificity, and NPV for lymph node metastasis, but its diagnostic sensitivity for metastatic lesions was lower than [18F]FDG PET/CT. Therefore, [68Ga]Ga-DOTA-FGFR1 can be used as an effective supplement to [18F]FDG to a certain extent.

Clinical analysis and follow-up results of 25 children with glycogen storage disease

Objective: To investigate the clinical characteristics, genetic characteristics and follow-up of hepatic glycogen accumulation in order to further improve the prognosis of children with hepatic glycogen accumulation. Methods: Clinical data of hospitalized children diagnosed with hepatic glycogen accumulation disease in the Department of gastroenterology, Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2010 to April 2023 were collected and retrospectively analyzed. The results of laboratory examination and gene sequencing were analyzed, and the patients with more than 3 cases (n) were grouped according to the genetic results: Group 1 was type Ⅰ (n=8), group 2 was type Ⅲ (n=5), and group 3 was type Ⅸ a (n=8). The growth, development and prognosis of the children were followed up, and the related clinical characteristics of pediatric hepatic glycogen accumulation were summarized. Results: A total of 25 children with hepatic accumulation of glycogen were included in the study, including 15 males and 10 females. The mean age of diagnosis was (29.1±13.5) months. There were 12 cases (48%) with varying degrees of hypoglycemia, and 2 cases (8%) with severe hypoglycemia. There were 19 cases with height retardation (76%), 4 cases with anemia (16%), 3 cases with proteinuria (12%), and 1 case with cholestasis (4%). The genetic results showed that there were 4 cases of type Ⅰ a (16%), 4 cases of type Ⅰ b (16%), 1 case of type Ⅱ (4%), 5 cases of type Ⅲ (20%), 2 cases of type Ⅳ (8%), 1 case of type Ⅵ (4%), and 8 cases of type Ⅸ (32%). By analyzing the three subgroups, there were statistically significant differences in uric acid and triglyceride (P<0.05), while there were no statistically significant differences in aminotransferase levels, fasting blood glucose, lactic acid, cholesterol and low density lipoprotein levels (P>0.05). The height-specific age Z scores of the three groups were compared, which were -2.86±1.62, -1.46±1.06 and -1.83±0.98, respectively. After at least 1 year of follow-up, the growth and development of groups 2 and 3 were significantly improved compared with group 1 (P<0.05), and the Z scores were -2.28±1.07, 0.20±1.54 and 0.10±1.44. After more than 1 year of follow-up, all the children with type IX had stopped using raw corn starch and had normal transaminase. 4 patients with type Ia were taking raw corn starch orally regularly. Aminotransferase, uric acid and lactic acid were normal, and hypoglycemia was detected among them.Among the 4 cases of type Ⅰb, 1 case had recurrent respiratory and intestinal infections, and 2 cases had Crohn's disease.4 cases of type Ⅲ had stopped using raw corn starch and adopted high protein and low carbohydrate diet. The aminotransferase was normal except for high creatine kinase. One case of type Ⅵ died of liver failure.2 cases were type Ⅳ, 1 died and 1 had a slightly elevated transaminase level. Conclusion: When it is found that the children have liver enlargement, elevated aminotransferase, fasting hypoglycemia, and backward growth and development, it is necessary to be vigilant about liver glycogen accumulation.Clinical manifestations, biochemical indicators combined with genetic examination are helpful for the diagnosis of hepatic glycogen accumulation. Meanwhile, nutritional management is targeted according to the metabolic characteristics of different subtypes, and attention is paid to growth and development.

Fundoplication for Pediatric Gastroesophageal Reflux Disease: Indications, Techniques, and Outcomes.

Background This study aimed to evaluate the indications, techniques, and outcomes of fundoplication in pediatric patients with gastroesophageal reflux disease (GERD) at a tertiary hospital in Yemen. Methods A prospective cohort study was conducted at Al-Thawra Modern General Hospital, Sana'a, Yemen, between January 2015 and January 2022. The study included 45 pediatric patients under 18 years of age who underwent fundoplication for GERD. Data on demographic and clinical characteristics, surgical type, postoperative complications, and follow-up outcomes were collected and analyzed. Results The median age of the 45 pediatric patients was two years (range: two months to 10 years), with 25 males (56%) and 20 females (44%). The primary indications for fundoplication included GERD with hiatal hernia in 20 patients (44.4%), persistent symptoms despite medical management in 9 patients (20%), recurrent chest infections associated with neurological disorders in 7 patients (15.6%), esophageal stricture in 8 patients (17.8%), and both hiatal hernia and esophageal stricture in 1 patient (2.2%). Nissen fundoplication was performed in 36 patients (80%), and Thal fundoplication was performed in 9 patients (20%). Complete symptom resolution was achieved in 31 patients (68.89%). Dysphagia due to postoperative esophageal stricture was the most common complication, affecting 13 patients (29%). A structured dilatation protocol resulted in improvement after one session in four patients (30.8%), regular sessions in six patients (46.2%), and irregular sessions in three patients (23.1%). The mortality rate was two patients (5.56%), both of whom had cerebral palsy and died due to recurrent chest infections unrelated to GERD recurrence or esophageal stricture. Conclusions Fundoplication is a safe and effective surgical treatment for pediatric GERD, with a high success rate and manageable complications. A structured postoperative dilatation protocol is essential for managing esophageal strictures and improving outcomes. Early diagnosis and intervention, alongside adherence to postoperative protocols, are crucial for optimal results. Further research with larger sample sizes and long-term follow-up is recommended to confirm these findings and improve clinical practice.

Is it safe to treat osteoporotic burst thoracolumbar fracture using percutaneous vertebroplasty? A minimum of 5-year follow-up study

BACKGROUND CONTEXTPercutaneous vertebroplasty for the treatment of osteoporotic burst fractures remains controversial. A previous study has shown that an osteoporotic burst fracture with asymptomatic spinal canal compromise is not a contraindication for percutaneous vertebroplasty. PURPOSETo determine whether these outcomes persist over a long term, we continued to observe patients in their short-term study over a long-term period. STUDY DESIGNProspective study. PATIENT SAMPLEPatients with osteoporotic vertebral fractures were classified as Dennis type I and II and AO type A1-A4, and no neurological deficits were observed. OUTCOME MEASURESOswestry disability index and visual analog scale (VAS11VAS, visual analogue scale.) for pain were outcome measures. Radiological outcomes were vertebral body height and kyphotic angle. Complications included cement leakage, adjacent fractures, and transition to instrumented fusion. METHODSBetween June 2015 and December 2016, 96 patients with osteoporotic vertebral fractures who met the inclusion criteria were prospectively enrolled. Preoperative, postoperative, and latest follow-up clinical outcomes were assessed using the Oswestry disability index and VAS. The radiological outcomes included vertebral body height, kyphotic angle, and adjacent fractures. Patients with intractable pain and neurological deficits during the follow-up were indicated for surgical treatment using decompression and instrumented fusion. RESULTSFifty-one patients with osteoporotic compression fractures and 45 with osteoporotic burst fractures were included in this study. Mean follow-up duration was 74 months, and posterior vertebral body height, kyphotic wedge angle, and VAS score were not altered during the follow-up period. Three (5.9%) patients in an osteoporotic compression fracture group and three (6.7%) in a osteoporotic burst fracture group developed persistent pain, further collapse, and neurological deficits, and were indicated for surgical treatment. No significant differences were observed in the rates of adjacent fractures. Percentage of patients who required surgical treatment was not significantly different between the groups. CONCLUSIONSOsteoporotic burst fractures with asymptomatic spinal canal compromise treated with percutaneous vertebroplasty are safe and effective for pain management during long-term follow-up.

Robot-assisted kidney transplantation: initial experience from a tertiary hospital in China

Abstract Background Robot-assisted kidney transplantation (RAKT) has currently become an effective alternative to open kidney transplantation (OKT), which has long been considered the gold standard for kidney transplant surgery. This study aimed to summarize our initial experience with RAKT and explore its safety and feasibility. Materials and methods Ten cases of RAKT, including 8 cases of deceased-donor kidney transplantation and 2 cases of living-donor kidney transplantation, were performed at our center from March 2023 to November 2023. Perioperative clinical data and follow-up results of patients were collected and statistically analyzed. Results All RAKT surgeries were performed successfully with no complications. The average operative time was 297.90 ± 65.59 minutes, and the median estimated blood loss was 100 mL. The average serum creatinine level decreased from 918.14 ± 166.63 μmol/L preoperatively to 109.89 ± 29.89 μmol/L at discharge. The postoperative outcomes of RAKT from both deceased and living donors were satisfactory during the follow-up period. Conclusions RAKT is an effective alternative to OKT and is suitable for both deceased- and living-donor kidney transplantations. The postoperative outcomes were satisfactory, and the postoperative complications were acceptable. RAKT appears to be a safe and feasible procedure for transplantation teams skilled in OKT and robot-assisted surgery.