Root Involvement Research Articles

A Rare Case of Epithelioid Hemangioma Presenting as an Isolated Sacral Mass

Epithelioid hemangioma (EH) is an uncommon benign vascular tumor of mesenchymal origin. It mainly presents as expanding nodules around the ear, the forehead, and long bones. Only a handful of cases have been found in cervical, thoracic, lumbar, and sacral vertebrae as lytic lesions with pain and neurological impairment. We present the case of a 36-year-old female with an incidental finding of a sacral mass along with inguinal lymphadenopathy on imaging. Initially, there were no symptoms. The mass gradually progressed and later showed an extraosseous extension with involvement of sacral neural foramina and nerve roots causing severe low back pain and weakness of the left lower extremity. Differential diagnoses initially included secondary metastases and chordoma. However, the biopsy of the mass revealed findings consistent with an EH. To our knowledge, this is the first case of EH presenting as an isolated mass in the sacrum and the third case of EH involving the sacrum in continuation with other vertebrae.EH should be in our differential diagnoses when there is a sacral mass.

P.216 Two interesting and unique cases of acquired neuropathies in pediatrics

A 2-year-old boy known for an abdominal neuroblastoma was admitted after his fourth cycle of chemotherapy for generalized deterioration and pain when weight bearing. Multiple investigations and medication trials were made without finding the cause or relieving the patient's pain. While in hospital, the pain worsened and he developed gastroparesis, psychomotor regression and respiratory distress. A sensory polyneuropathy was confirmed by NCS, and the diagnosis of anti-Hu syndrome was subsequently made by CSF and serum paraneoplastic antibody panel. He received high-dose steroids, plasmapheresis, rituximab and cyclophosphamide, without clear improvement. After a few weeks, he underwent surgical resection of his neuroblastoma and was started on daratumumab bimonthly, mycophenolate mofetil and monthly IVIG after which he finally mildly improved. In summary, anti-Hu syndrome, while extremely rare in pediatrics, must be included in the differential diagnosis of refractory pain in children with a tumor diagnosis. A 15-year-old boy with no previous health issue presented with a subacute onset paraparesis. He had been recently diagnosed with diabetes of unknown type after a weight loss of 45 kg and started on insulin. He presented with progressive bilateral leg weakness, and the physical exam showed asymmetric weakness and decreased reflexes in the lower limbs, as well as sensory loss in a distal-to-proximal gradient. Investigations, such as a spine MRI and blood tests, showed no abnormality except for high HbA1c. The EMG and NCS confirmed involvement of multiple nerves and nerve roots with axonal loss. The final diagnosis was radiculo-plexo-neuropathy related to diabetes type II. The patient refused immunotherapy, and then completely recovered when his treatment was adjusted for diabetes type II.

NSAIDs in sciatica (NIS): study protocol for an investigator-initiated multicentre, randomized placebo-controlled trial of naproxen in patients with sciatica

BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat sciatica, despite insufficient evidence from placebo-controlled trials. NSAIDs may cause serious side effects; hence, there is a strong need to clarify their potential beneficial effects in patients with sciatica.MethodsThis is a multicentre, randomized, placebo-controlled, parallel-group superiority trial. Participants will be recruited among sciatica patients referred to outpatient clinics at hospitals in Norway who have radiating pain below the knee with a severity score of ≥ 4 on a 0–10 numeric rating scale and clinical signs of nerve root or spinal nerve involvement. The intervention consists of oral naproxen 500 mg or placebo twice daily for 10 days. Participants will report the outcomes and adverse events daily using an electronic case report form. The primary endpoint is change in leg pain intensity from baseline to day 10 based on daily observations. The secondary outcomes are back pain intensity, disability, sciatica symptom severity, rescue medication (paracetamol) consumption, opioid use, ability to work or study, 30% and 50% improvement in leg pain, and global perceived change of sciatica/back problem. The outcomes will be analysed using mixed effects models for repeated measurements. The total duration of follow-up is 12 (± 2) days.DiscussionThis trial aims to evaluate the benefits of naproxen, a non-selective NSAID, in patients with sciatica. No important differences in efficacy have been demonstrated between different NSAIDs in the management of musculoskeletal disorders; hence, the results of this trial will likely be applicable to other NSAIDs.Trial registrationClinicalTrials.gov NCT03347929. Registered on November 20, 2017.

P.171 Intradural-extramedullary spinal cavernoma with nerve root association: a case report and review of the literature

Background: Although 5% of cavernomas occur in the spine, intradural-extramedullary cavernomas are exceptionally rare. We present one such case of cavernoma associated exclusively with a nerve root, and review the literature for similar lesions. Methods: Case Report. A 45-year old male patient presented with a six-month history of numbness and paresthesia affecting his lower extremities bilaterally. MRI demonstrated a 16mm intradural-extramedullary lesion at T3-4, compressing the cord. The lesion was surgically removed en-bloc, requiring root sacrifice. The patient’s symptoms completely resolved post-operatively, and he remained asymptomatic at 3-month follow up. Results: Including the present case, 71 cases of intradural-extramedullary spinal cavernoma have been reported, including 50 with confirmed nerve root involvement. Patients most frequently presented between the ages of 40-59 (41%) with lesions at the lumbar level (54%). Confirmed subarachnoid hemorrhage was present in 14% at presentation, although 23% presented acutely. 49% presented with longstanding/progressive symptoms, and 11% with mixed acute-on-chronic presentation. 37% presented primarily with radiculopathy, 21% with myelopathy, and 11% with pain. Good postoperative recovery was documented in 80% of cases. Conclusions: Intradural-extramedullary spinal cavernomas may demonstrate a propensity for radiculopathy at presentation and exhibit substantial subarachnoid hemorrhage risk. Literature review supports the role of surgical resection.

Teaching NeuroImage: Intradural ALK-Positive Histiocytosis With Involvement of Nerve Roots and Spinal Dura.

A 3-year-old boy presented with progressive lower extremity weakness and difficulty walking for 2 months. Neurologic examination found the muscle strength of his left lower limb was grade 3 and tendon reflex was weakened. MRI demonstrated an intradural extramedullary mass between T10-11 with multiple and diffuse enhancement of thickened nerve roots and spinal dura (Figure). Juvenile xanthogranuloma was suspected as positive staining for CD68 and negative for S100 and CD1a, while immunoreactivity for ALK did not support it. The genetic test confirmed the diagnosis of ALK-positive histiocytosis with KIF5B-ALK fusion, which is a relatively new subtype of histiocytic disease.1,2

Auto-intestine transplantation for pancreatic tumors with mesenteric root involvement: A survival-based analysis

Auto-intestine transplantation for pancreatic tumors with mesenteric root involvement: A survival-based analysis

Long-Term Mortality in Different Age Groups of Patients with Infective Endocarditis Who Undergo Aortic Root Replacement: A Nationwide Study.

Infective endocarditis (IE) with involvement of the aortic root is associated with high short-term mortality and morbidity. Long-term data are sparse, and the existing studies with long-term data are restricted by a low number of patients and do not report mortality risks of different age groups. This study examined the all-cause mortality risk postoperatively of patients with first-time IE who underwent aortic root replacement (ARR), according to age at the time of surgery, with one and 10 years follow-up. Patients with first-time IE who underwent ARR surgery from 2000-2016 were identified in Danish nationwide administrative registries and divided into age groups: ≤60, 61-74, and ≥75 years. We compared one- and 10-year mortality risk using multivariable Cox regression across the three age groups. We identified 258 patients who underwent ARR (26.0% female, 42.6% with prosthetic valves, median age 64 years (IQR 55-73), of whom 98, 112, and 48 patients were ≤60 years, 61-74 years, and >75 years, respectively. The corresponding in-hospital mortality risk was 10.2%, 22.3%, and 29.2% (P = .01), respectively. The one-year postoperative mortality risk was 17.3%, 28.6%, and 33.3% (P = 0.05), while at 10 years after surgery, it was 31.8%, 62.9%, and 77.1% (P < 0.01), respectively. The adjusted 10-year hazard ratio was higher in the 61-74 and >75-year age groups (HR 1.94 [1.18-3.16] and 2.46 [1.35-4.49]) compared with the ≤60. Aortic root replacement in patients with first-time IE was associated with a high in-hospital and one- and 10-year mortality with worse outcomes with age.

Neoplastic nerve lesions.

Though metastasis and malignant infiltration of the peripheral nervous system is relatively rare, physicians should have a familiarity with their presentations to allow for prompt diagnosis and initiation of treatment. This article will review the clinical presentations, diagnostic evaluation, and treatment of neoplastic involvement of the cranial nerves, nerve roots, peripheral nerves, and muscle. Due to the proximity of the neural structure traversing the skull base, metastasis to this region results in distinctive syndromes, most often associated with breast, lung, and prostate cancer. Metastatic involvement of the nerve roots is uncommon, apart from leptomeningeal carcinomatosis and bony metastasis with resultant nerve root damage, and is characterized by significant pain, weakness, and numbness of an extremity. Neoplasms may metastasize or infiltrate the brachial and lumbosacral plexuses resulting in progressive and painful sensory and motor deficits. Differentiating neoplastic involvement from radiation-induced injury is of paramount importance as it dictates treatment and prognosis. Neurolymphomatosis, due to malignant lymphocytic infiltration of the cranial nerves, nerve roots, plexuses, and peripheral nerves, deserves special attention given its myriad presentations, often mimicking acquired demyelinating neuropathies.

Functional Outcome of Instrumentation and Interbody Cage Fusion in Cases of Lumbar Spondylolisthesis

Background: Primary lumbar vertebral instability or “spondylolisthesis” is perhaps one of the commonest radiological sign associated with lumbo-sacral pain after the third decade of life. Aims and Objectives: To find out the functional outcome in terms of clinical improvement in cases of single level lumbar spondylolisthesis by bone grafting and interbody cage fusion and pedicle screw fixation after decompression of neural elements. Materials and Methods: All the patients were evaluated by anteroposterior and lateral radiographs of the lumbosacral spine centered at the appropriate level. In all cases flexion and extension views were taken to assess the instability. More than 4 to 5 mm of sagittal translation and 10 degrees of rotation were considered as instability. All cases were evaluated further by MRI to evaluate facet joint pathology, sacralization/lumbarisation and to find the associated disc changes and the nerve root involvement. All patients were treated by decompression and interbody fusion with cage and bone graft by either Transforaminal or Posterior approach and instrumentation done with pedicle screws. Post operatively all patients were assessed for the functional outcome using the Oswestry Disability Index at 1 month, 3 month and 6 months Results: There is statistically significant difference in ODI Scores (Oswestry Disability Index) post operatively at 1 month, 3 month and 6 months. Conclusion: In agreement with good results, found in our study, we strongly believe that this technique of fusion and instrumentation is very useful in management of lumbar spondylolisthesis. However, this study should further be extended to a wider sample of patients with a longer follow-up.

Homer-3 Antibody Disease: A Potentially Treatable MSA-C Mimic.

Homer-3 Antibody Disease: A Potentially Treatable MSA-C Mimic.

Modelling the artificial forest (&amp;lt;i&amp;gt;Robinia pseudoacacia&amp;lt;/i&amp;gt; L.) root–soil water interactions in the Loess Plateau, China

Abstract. Plant root–soil water interactions are fundamental to vegetation–water relationships. Soil water availability and distribution impact the temporal–spatial dynamics of roots and vice versa. In the Loess Plateau (LP) of China, where semi-arid and arid climates prevail and deep loess soil dominates, drying soil layers (DSLs) have been extensively reported in artificial forestland. While the underlying mechanisms that cause DSLs remain unclear, they hypothetically involve root–soil water interactions. Although available root growth models are weak with respect to simulating the rooting depth, this study addresses the hypothesis of the involvement of root–soil water interactions in DSLs using a root growth model that simulates both the dynamic rooting depth and fine-root distribution, coupled with soil water, based on cost–benefit optimization. Evaluation of field data from an artificial black locust (Robinia pseudoacacia L.) forest site in the southern LP positively proves the model's performance. Further, a long-term simulation, forced by a 50-year climatic data series with varying precipitation, was performed to examine the DSLs. The results demonstrate that incorporating the dynamic rooting depth into the current root growth models is necessary to reproduce soil drying processes. The simulations revealed that the upper boundary of the DSLs fluctuates strongly with infiltration events, whereas the lower boundary extends successively with increasing rooting depth. Most infiltration was intercepted by the top 2.0 m layer, which was the most active zone of infiltration and root water uptake. Below this, the percentages of fine roots (5.0 %) and water uptake (6.2 %) were small but caused a persistently negative water balance and consequent DSLs. Therefore, the proposed root–water interaction approach succeeded in revealing the intrinsic properties of DSLs; their persistent extension and the lack of an opportunity for recovery from the drying state may adversely affect the implementation of artificial afforestation in this region as well as in other regions with similar climates and soils.

Possible donor nerves for axillary nerve reconstruction in dual neurotization for restoring shoulder abduction in brachial plexus injuries: a systematic review and meta-analysis.

Restoring shoulder abduction is one of the main priorities in the surgical treatment of brachial plexus injuries. Double nerve transfer to the axillary nerve and suprascapular nerve is widely used and considered the best option. The most common donor nerve for the suprascapular nerve is the spinal accessory nerve. However, donor nerves for axillary nerve reconstructions vary and it is still unclear which donor nerve has the best outcome. The aim of this study was to perform a systematic review on reconstructions of suprascapular and axillary nerves and to perform a meta-analysis investigating the outcomes of different donor nerves on axillary nerve reconstructions. We conducted a systematic search of English literature from March 2001 to December 2020 following PRISMA guidelines. Two outcomes were assessed, abduction strength using the Medical Research Council (MRC) scale and range of motion (ROM). Twenty-two studies describing the use of donor nerves met the inclusion criteria for the systematic review. Donor nerves investigated included the radial nerve, intercostal nerves, medial pectoral nerve, ulnar nerve fascicle, median nerve fascicle and the lower subscapular nerve. Fifteen studies that investigated the radial and intercostal nerves met the inclusion criteria for a meta-analysis. We found no statistically significant difference between either of these nerves in the abduction strength according to MRC score (radial nerve 3.66 ± 1.02 vs intercostal nerves 3.48 ± 0.64, p = 0.086). However, the difference in ROM was statistically significant (radial nerve 106.33 ± 39.01 vs. intercostal nerve 80.42 ± 24.9, p < 0.001). Our findings support using a branch of the radial nerve for the triceps muscle as a donor for axillary nerve reconstruction when possible. Intercostal nerves can be used in cases of total brachial plexus injury or involvement of the C7 root or posterior fascicle. Other promising methods need to be studied more thoroughly in order to validate and compare their results with the more commonly used methods.

Myeloradiculitis with lupus-like autoimmunity following Sinovac COVID-19 vaccination

We report a 67 year old man with features in keeping with transverse myelitis, lumbar root and cauda equina involvement suggestive of delayed autoimmune pathogenesis after the Sinovac COVID-19 vaccination previously observed in vaccines containing viral antigens. Grossly elevated antinuclear antibody and anti-double-stranded DNA are in line with observations in lupus myelitis despite the lack of systemic manifestations.

Auto-intestine transplantation for pancreatic tumors with mesenteric root involvement: a systematic review and survival-based analysis

Abstract To analyze a long-term survival outcome of an auto-intestine transplantation (aINTx) for the patients with locally advanced pancreatic tumor and identify the potential prognostic factors, databases were carefully searched for the studies reporting the patients with a locally advanced pancreatic tumor which typically underwent aINTx. We performed a database search using PubMed, the Cochrane Library, EMBASE, and MEDLINE to identify multiple case series of the patients who had pancreatic tumors with mesenteric root involvement and underwent aINTx, to evaluate the treatment outcomes, and calculated the patient survival using the Kaplan–Meier method and Cox proportional hazard regression analysis to properly identify an independent predictor of the survival. A total of 9 retrospective studies with a total of 29 patients were included in our study. The calculated 1-, 2-, and 3-year survival rates for the patients with pancreatic cancer and benign or low grade pancreatic tumors were 49.64%, 22.06%, and 0% versus 100%, 100%, and 80%, respectively. The corresponding median survival time was 13.4 months and 84 months, respectively. Moreover, when stratifying the pancreatic cancer patients undergoing aINTx on the basis of neoadjuvant chemotherapy (aINTx + neoadjuvant vs aINTx - neoadjuvant) there was a significant difference in the survival (P = .01). The 1- and 2-year survival rates were 75% and 75% versus 34.1% and 0%, respectively. Corresponding median survival times were 24 months and 10 months, respectively. Our analysis shows the long-term survival benefit with acceptable morbidity and mortality of pancreatoduodenectomy and aINTx for the pancreatic tumors with the mesenteric root involvement that are otherwise unresectable by the conventional surgical techniques. However, from an oncological point of view, a larger study with the control group is required to determine its safety compared to less aggressive surgical treatment.

Sex Differences in Proximal Thoracic Aortic Disease Pathology: A Call to Action

Abstract Introduction/Objective Sex disparity is reported across all forms of cardiovascular diseases. Only few studies have focused on sex differences in thoracic aortic disease pathology. We aim to identify and understand sex differences in this patient group to bridge the knowledge gap and improve clinicopathologic outcomes. Methods/Case Report This is a retrospective analysis of 83 proximal thoracic aortic aneurysm and dissection (TAAD) cases treated at a single quaternary care center in 2019. Chart review was done for demographics. Consensus criteria (Stone JR et al. Cardiovasc Pathol 2015; 24:267-78; Halushka MK et al. Cardiovasc Pathol 2016; 25:247-57) and a scoring system (Waters KM et al. Cardiovasc Pathol 2017; 30:6-11) were used for pathology reporting. Clinical correlation was also made. Pearson’s chi-square test was used for statistical analysis. Results (if a Case Study enter NA) 83 patients (61 male and 22 female) were retrieved. Overall thoracic aortopathy was higher among males, accounting for 73.4% of individuals with TAAD. In a subgroup analysis, there was no sex difference in dissection, aortic root involvement, and bicuspid aortic valve (p&amp;gt;0.05). Genetic aortopathy was more prevalent in females than males (27.2% vs 9.8%, p=0.04) alongside early age at first aortic event (median age: 31y vs 52y). Histopathologically, females had frequent translamellar mucoid extracellular matrix accumulation (45.4% vs 22.9%, p=0.04), extensive (54.5% vs 27.8%, p=0.02) and severe (59% vs 34.4%, p=0.04) elastic fiber fragmentation, higher band like (9% vs 6.5%, p&amp;gt;0.05) plus extensive (13.6% vs 4.9%, p&amp;gt;0.05) smooth muscle nuclei loss, and extensive (13.6% vs 1.6%, p=0.01) plus dense (4.5% vs 1.6%, p&amp;gt;0.05) laminar medial collapse than males. Conclusion In our patient population, females have a lower prevalence of thoracic aortic disease treated with open repair. However, those who develop TAAD harbor a greater burden of wall pathology and probable worse outcomes. We recommend sex-based analysis of all research on thoracic aortic diseases.

The Impact of Surveillance Imaging After Curative Intent Radiotherapy for Limited Stage Follicular Lymphoma

Approximately 50% of patients treated with curative intent radiotherapy for limited stage follicular lymphoma (FL) will have a lymphoma relapse. The ideal follow-up strategy for detecting relapse is uncertain. The purpose of this study was to evaluate the impact of surveillance imaging (SI) in patients treated with radiotherapy for limited stage follicular lymphoma (FL).Patients with limited stage IA-IIA, grade 1-3A, FL treated with curative intent radiotherapy alone between 2000-2015 were retrospectively reviewed. Relapse detection was categorized into clinical detection (investigations based on signs/symptoms or laboratory abnormalities) or SI detection (radiologic investigations in asymptomatic patients). Survival outcomes were stratified based on method of relapse detection.A total of 330 patients were included with a median follow-up of 8.1 (0.5-20.0) years. All patients received ≥20Gy of involved site radiotherapy (ISRT). 222 (67.3%) patients had SI investigations with a mean of 0.4 (0.1-1.7) per year of follow-up. The most common SI modality used was computed tomography (48.6%). Of all SI investigations (n = 830), 761 (91.7%) showed no evidence of relapse, 49 (5.9%) showed findings of suspected relapse that were that were subsequently found to be false positive, and 20 (2.4%) led to confirmed relapse. The resulting positive predictive value and specificity of SI was 29.0% and 94.0%, respectively. In the follow-up period, 146 (44.2%) patients had a relapse; 126 (86.3%) were detected clinically and 20 (13.7%) were detected with SI. In relapses that were clinically detected (n = 126), 11 (8.7%) were associated with clinically significant patient morbidity, manifesting as deep vein thrombosis (n = 2), pleural effusion (n = 1), biliary duct obstruction (n = 1), renal failure (n = 2), spinal cord or nerve root involvement (n = 4), or symptomatic hypercalcemia (n = 1). The 5- and 10-year overall survival (OS) from the date of diagnosis were 85.6% and 65.2% for clinically detected versus 84.7% and 74.1% for SI detected relapses (P = 0.71). The 5- and 10-year OS from the date of relapse were 70.1% and 50.6% for clinically detected versus 80.2% and 59.4% for SI detected relapses (P = 0.54).This retrospective cohort revealed no significant OS differences between relapse detection by SI versus clinical assessment. The incidence of morbidity was low in relapses that were detected clinically. Only 2.4% of SI investigations led to a confirmed relapse suggesting they may have limited utility in the follow-up of limited stage FL patients treated with curative intent radiotherapy. A prospective analysis of cost-effectiveness and impact of SI on psychological and physical morbidity may help guide clinicians when considering a SI follow-up strategy.

Rare association of traumatic diaphragmatic hernia with spinal cord injury: A case report.

Introduction and importanceThe traumatic diaphragmatic hernia could be missed in the background of spinal fractures due to neurological weakness. We report the first case of the management of thoracolumbar fracture-dislocation associated with diaphragmatic injury.Presentation of case53-year-old male transferred from local hospital following fallen from a motorbike on the 4th day after the injury. He was paraplegic from L1 below with sacral root involvement. Further imaging showed fracture-dislocation of the vertebral body at the T12-L1 level and anterior displacement of T11 on T12. The left-sided diaphragmatic hernia was detected by chest x-ray with bowel shadows in the left hemithorax. Emergency laparotomy and diaphragmatic repair followed by a posterior spinal exploration and pedicle screw fixation were done. Early mobilization was done after spinal fixation and the patient is successfully continuing rehabilitation.Clinical discussionThoracolumbar fracture-dislocation associated with the traumatic diaphragmatic hernia is rare. Clinical diagnosis of associated visceral injuries could be delayed due to the neurological deficit of the patient. An initial concern was to repair the life-threatening diaphragmatic hernia. Even current studies showed improved neurological function from early spinal surgery, spinal fixation had to delay as surgery needs a prone position.ConclusionEarly identification and management of traumatic diaphragmatic hernia are life-saving and allows early surgical intervention for the spine. Early reduction and fixation are associated with improved neurological function and will allow early mobilization and reduce hospital and ICU stay.

Early and mid-term outcomes of modified aortic root repair for acute stanford type A aortic dissection

Abstract Background Acute Stanford type A aortic dissection (ATAAD) is the most common catastrophic aortic event. Most ATAAD involves the aortic root which has many important anatomical structures such as aortic valve, so the proper treatment of dissected root can ensure a good prognosis for patients. However, there is still no consensus on root management strategies for ATAAD patients with aortic root involvement. Purpose This clinical study aimed to evaluate the therapeutic effect of modified aortic root repair in ATAAD. Methods From September 2017 to September 2020, Participants with root involvement of ATAAD were recruited who underwent modified aortic root repair as well as some additional procedure such as aortic valve junction suspension plasty based on the aortic sinus tear extent. During this novel procedure, the proximal anastomosis plane was at the level of the sinu-tubular junction and the false lumen below it was retained. We collected and analyzed the perioperative clinical data and follow-up imaging data of patients, and further evaluated the early and mid-term efficacy of this surgical approach. Results A total of 79 patients were enrolled, including 59 males and 20 females, the age was (52.4±11.3) years old (28–73 years), the diameter of aortic sinus was (38.6±4.1) mm, and the diameter of sinu-tubular junction was (41.8±4.8) mm. In this group, 75 patients (94.9%) received ascending aorta replacement, total arch replacement and frozen elephant trunk, 2 patients (2.5%) received ascending aorta replacement and hybrid total arch replacement, 2 patients (2.5%) received ascending aorta replacement and partial arch replacement. Cardiopulmonary bypass time was (197.2±58.6) min (118–455 min), blocking time was (132.6±38.9) min (73–323 min), circulatory arrest time was (10.3±7.0) min (0–27 min). There was no perioperative death, no paraplegia, one secondary thoracotomy, five renal failures needing hemodialysis treatment and two cerebral infarctions. Before patients discharged, aortic CTA showed that the residual false lumen in the sinus disappeared. And the diameter of the aortic sinus was (35.5±3.1) mm, the diameter of the junction of the aortic sinus was (30.0±3.0) mm. The patients were followed up for (18±12) months (3–35 months). There was one patient died during follow-up and no further surgical intervention at the root of the aorta. Follow-up aortic CTA showed no residual or new dissection in the aortic sinus and no significant difference in the diameters of aortic sinu-tubular junction (P=0.122) or aortic sinus (P=0.37) between postoperative period and follow-up period. Echocardiography showed that the structure and function of the aortic valve were normal. Conclusions The modified aortic root repair for ATAAD is relatively simple, easy to learn and safe in perioperative period. Early and mid-term follow-up image examination showed that the structure of aortic sinus returned to normal. The long-term clinical effect requires close attention. Funding Acknowledgement Type of funding sources: None. Modified aortic root repair procedureAortic root diameter change under CTA

Clinical pattern and outcome of spinal cord involvement in tuberculous meningitis

Tuberculosis (TB) is a common infection worldwide. Approximately one third of the entire world population is infected with TB. Involvement of spinal cord and spinal nerve root is one of the leading causes of disability in these patients and it has a significant impact on morbidity and mortality. Through this study we aim to study the incidence, prognosis and impact of different types of spinal cord involvement in patients of CNS TB.

Association between radicular low back pain and constipation: a retrospective cohort study using a real-world national database.

Previous observational studies have reported an association between lumbosacral radiculopathy (LSR), a form of low back pain (LBP) with nerve root involvement, and constipation. However, it is unclear whether this association is due to confounding variables such as comorbidities and medications. This study explores the possible association between LSR and constipation, with the hypothesis that adults with LSR have increased odds of developing constipation compared with those with nonradicular LBP. Adults aged 18 to 49 years with incident LSR and nonradicular LBP were identified from a national 70 million patient electronic health records network (TriNetX). Propensity score matching (PSM) was used to control for covariates and determine the odds ratio (OR) of constipation over a 1-year follow-up. Lumbar stenosis, cauda equina syndrome, and inflammatory bowel diseases were excluded. After PSM, 503,062 patients were in each cohort. Before PSM, the likelihood of constipation was identical between cohorts (LSR 10.8% vs 10.9%; OR [confidence interval] = 0.99 [0.98-1.0], P = 0.251). This association was unchanged after PSM (LSR 10.8% vs 11.1%; OR [confidence interval] = 0.98 [0.97-0.99]; P = 0.003). The study hypothesis can be refuted given that the OR approximated the null in a large propensity-matched sample. Patients with LSR have equivalent odds of constipation compared with those with nonradicular LBP, suggesting that LSR is not a direct cause of constipation. The similar risk of constipation between cohorts could be explained by factors common to LBP in general, such as pain severity, physical inactivity, and constipating medications.