Single Institution Research Articles

Efficacy of Molding Helmet Therapy following Suturectomy for Craniosynostosis: A Single-center, Retrospective Analysis in Japan

Craniosynostosis limits normal cranial growth, significantly affecting the growth and development of children. This increase in intracranial pressure results in significant cosmetic and functional losses. This study investigated the efficacy of combining molding helmets with suturectomy for craniosynostosis. Patients who underwent suturectomy and molding helmet therapy for craniosynostosis at a single institution between 2017 and 2024 were included. Changes in cephalic index (CI) and cranial vault asymmetry index (CVAI) were analyzed. A total of 14 patients (12 males, 2 females) were included, with a median age of 4.5 months (2–6 mo). The affected sutures were as follows: sagittal (n=8), bilateral coronal (n=4), unilateral coronal (n=1), and lambdoid (n=1) sutures. The median duration of postoperative molding helmet therapy was 44.5 weeks. For the sagittal suture group, the median preoperative CI, median postoperative CI, and rate of change were 72.0 (68.3–85.8), 77.0 (72.1–86.4), and 0.0646, respectively. For the bilateral coronal suture group, measurements for the same parameters were 104.0 (99.3–110.0), 92.5 (89.1–94.5), and 0.1114, respectively. For the unilateral coronal group, the measured parameters were 89.0 (87.7–91.2), 84.0 (81.2–87.1), and 0.059, respectively. Although all suture types showed improvement in cranial shape, with sagittal synostosis showing the most significant change, our findings did not support the added benefit of molding helmet therapy. Overall, the study suggests that suturectomy is a crucial first step in craniosynostosis treatment, leading to improvements in cranial morphology and growth.

Regional distribution of anaplastic thyroid cancer in the United States

Abstract Introduction/Objective Anaplastic thyroid cancer (ATC) is an aggressive rare malignancy found in less than 2% of thyroid cancer patients. Its low occurrence rate presents challenges for collecting sufficiently large cohorts at a single institution, making statistical analysis about the disease’s spread, geographical distribution, and prevalence difficult. Nationwide data lakes such as Oracle EHR Real-World Data (ORWD, formerly Cerner Real World Data) offer a boost in cohort sizes and an opportunity to study ATC’s geographical distribution and assess regional differences. Methods/Case Report We searched ATC distribution across US regions defined by ZIP codes recorded in ORWD using multiple coding parameters, including ICD9, ICD10, and SNOMED as well as direct text searches for “anaplastic thyroid carcinoma”. We analyzed the geographical associations defined by ORWD (region) with sex, race, and age of ATC onset using the Fisher’s exact test. We combined 10 regions into 4 representative groups because of the small sample size. The groups are West Coast including the Rockies, Midwest from North Dakota to Texas, East Coast, and New England. Results (if a Case Study enter NA) Search for ATC condition codes in ORWD produced only 200 region-coded patient records across the US using multiple methods to try and identify cases. The mid-section of the US and coastal regions shows the highest numbers of ATC patients while New England and South regions show the lowest. While more women have ATC overall, the East Coast group has significantly more males (p value = 0.04). ATC is a predominantly white disease (79.8% overall) with black population increasing in East Coast group and other races (Asian/Undeclared) in West Coast (p-value < 0.001). There appears to be no significant association between age of ATC onset and the geographical groups. Conclusion The data shows geographic differences in distribution of ATC although this preliminary analysis neither explains the nature of these differences nor allows for a clearer view. The rarity of the disease complicates data analysis. This study was also limited by number of cases retrievable from the database itself and lack of granularity in coding available for ATC to find cases of interest, highlighting the difficulty of accurate tumor classifications in large data lakes. Further research into geographical distribution and environmental factors (radioactivity, pollution) of thyroid cancer using more advanced tools, such as GeoSpark, are planned.

Accelerated radiotherapy in the treatment of anal squamous cell carcinoma – a single institution retrospective evaluation

Accelerated radiotherapy in the treatment of anal squamous cell carcinoma – a single institution retrospective evaluation

Benefits of Practicing Teaching as a Resident: A Single Institute Experience of a Formal Teaching Curriculum for Pathology Residents

Abstract Introduction/Objective The practice of near-peer teaching, both in lecture style and small group formats, has been shown to have benefits for the educator in improving communication skills, gaining knowledge in a subject, and providing a tangible experience that may aid in applying for employment. The purpose of this study is to present the current curriculum and teaching opportunities at the Medical University of South Carolina (MUSC) and their impacts on developing pathology residents’ teaching skills and perceptions of their growth as educators. Methods/Case Report Data regarding curriculum format and learner surveys for various teaching programs at MUSC was gathered from residency program leadership and the MUSC College of Medicine. An anonymous survey was distributed to current MUSC pathology residents to assess their participation, current comfort level, and comfort level prior to the start of residency in regard to various teaching modalities. Results (if a Case Study enter NA) The resident curriculum offers teaching modalities such as small group co-leader for medical students, didactic presentations, and on-the-job teaching. On a Likert scale of 1 to 5, with 5 being very comfortable, residents reported an average comfort level with teaching before starting residency as 2.11 and a current comfort level with teaching as 2.67. Residents were split on their perception of what affect residency has had on their comfort in teaching. Medical student evaluations of their small group teaching sessions co-led by pathology residents averaged 77.6% approval per course. Conclusion Through providing an overview of required and voluntary teaching opportunities offered at one institute and residents’ perceptions on their experiences while teaching there, we hope to both provide curriculum examples for other institutions and to advocate for placing greater importance on providing opportunities for residents. Such opportunities to practice teaching help them develop skills to benefit them as pathologists and in their future employability.

African American Females are More Vulnerable to Develop Biliary Injury in NAFLD (Nonalcoholic fatty liver disease) Patients – A Single Institute Experience

Abstract Introduction/Objective Chronic alcohol exposure alone may take decades to induce severe liver disease, yet when combined with elements such as the Western diet, liver pathogenesis accelerates, resulting in earlier symptoms. Identifying the specific contributions of alcohol, diet, and other factors to liver disease is challenging, despite the availability of diagnostic tools like patient histories, liver enzyme tests, imaging, and biopsies. Methods/Case Report This study seeks to detail the liver disease profile of patients who underwent liver biopsies in 2022. Comprehensive profiles were created by retrieving liver biopsy specimens and associated diagnostic data from electronic medical records. Two independent pathologists analyzed the biopsy slides, looking for liver damage associated with alcohol consumption and Western diet influences. We employed enhanced staining techniques to better associate specific types of liver damage with demographic variables. The data analysis was conducted using GraphPad Prism 9 for robust statistical evaluation. Results (if a Case Study enter NA) The research included 88 participants—41 males and 47 females, with average ages of 56 and 62 respectively. The predominant diagnosis was fatty liver disease, with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) accounting for 26% of cases, and alcoholic liver disease (ALD) making up 10%. The NAFLD/NASH group (n=23) consisted mainly of African Americans (n=15) and Caucasians (n=8). Among these, African Americans showed a significantly greater ductular reaction and portal inflammation (p<0.05). Conversely, no notable differences in portal fibrosis and bile stasis were observed between these groups. Notably, African American females (n=11) demonstrated more severe pathological features compared to Caucasian females (n=6), including elevated levels of ductular reaction, fibrosis, portal inflammation, and bile stasis (p<0.05), suggesting a higher vulnerability to biliary injuries. Conclusion The study highlights the complex interplay between lifestyle factors and liver disease development and emphasizes the need for precise diagnostic strategies that consider these multifactorial influences. Additionally, it reveals ethnic disparities in the pathology of NAFLD, advocating for further research into their causes and implications for clinical management. Future investigations should focus on race and gender-specific factors and adapt local healthcare strategies to effectively manage the escalating burden of liver disease.

Analysis of the Effeectiveness of the Integrated Law Enforcement Center (Gakkumdu) in Criminal Enforcement of the 2024 Election in Central Java based on the Principle of Legal Certainty

This study aims to analyze and examine the effectiveness of the Integrated Law Enforcement Center (Gakkumdu) in criminal enforcement of the 2024 Election in Central Java. This type of research is empirical or non-doctrinal law, the nature of analytical descriptive research. Using a qualitative approach with primary data from interviews and observations. Secondary data from books, scientific journal articles and legislative review. The results of the study show that the Central Java Gakkumdu Center has carried out its functions and authorities as a center for criminal law enforcement activities in accordance with the Election Law and Perbawaslu, but it has not been effective and legally certain. Because in handling election crime cases in 35 districts/cities as many as 110 cases, only 5 cases have permanent legal force, 2 cases stopped at the Police investigation, and 103 cases stopped at the discussion of the Gakkumdu Center. The causal factors are not in accordance with the theory of the legal system of law: (1) Legal substance: (a) the time to handle the case of election crimes is short (Speedy trial), (b) the legal subject of the perpetrator of the election crime is not fulfilled, (c) lack of evidence in the investigation of election crimes, and (d) difficulties in finding witnesses in the investigation of election crimes. (2) Legal structure: (a) many institutions in the Gakkumdu Center make coordination difficult, (b) different perceptions between institutions in the Gakkumdu Center make it difficult to determine election crimes, (c) the Gakkumdu Center is a non-institutional coordination forum in election crime enforcement, (d) the election crime enforcement coordinator Bawaslu only forwards reports and not as an election crime investigator. (3) Legal culture: (a) lack of understanding of election crime violations, (b) lack of public awareness of reporting election crimes to the gakkumdu center, (c) lack of public willingness to witness election crime cases, and (d) weak legal awareness of election participants to comply with the election law. The solutions to overcome the ineffectiveness of the Gakkumdu Center in election crime enforcement in the future: (a) the need for a single institution in election crime enforcement, and (b) the strengthening of Bawaslu's authority in election crime enforcement

The Effect of the Adoption of the National Accreditation Program for Rectal Cancer Process on Compliance Standards at a Single Institution.

Background: The National Accreditation Program for Rectal Cancer (NAPRC) was developed to enhance the quality of rectal cancer care in the United States. This project compared NAPRC compliance at a single tertiary care academic hospital before and after the institution adopted these standards in 2019. Methods: Rectal cancer patients from 2016 to 2023 who met NAPRC eligibility criteria were retrospectively reviewed for compliance with pre-selected patient care standards. Patients diagnosed prior to August 1, 2019 (pre-NAPRC) were compared with those diagnosed afterward (post-NAPRC) to determine whether compliance with these standards differed following the institution's adoption of new guidelines. Results: This study included 353 patients, 146 pre-NAPRC and 207 post-NAPRC. The post-NAPRC group demonstrated significantly higher compliance with pretreatment standards compared to the pre-NAPRC group, including attaining magnetic resonance imaging (MRI) (P = .015), computed tomography (CT) (P < .001), and a carcinoembryonic antigen (CEA) level (P < .001). Postoperative standards were more frequently met in the post-NAPRC group regarding the photographing of surgical specimens (P < .001). No significant differences were observed in confirming a tissue diagnosis, starting treatment within a 60-day timeframe, or completing surgical pathology reports. Prior to initiation of the NAPRC process, the institution had achieved accreditation-level compliance in 2 of the 7 standards. Within 2years of adopting NAPRC standards, complete compliance was met in 6 of the 7 measures. Conclusions: A single institution's adoption of NAPRC standards improved compliance with multiple rectal cancer care standards, achieving near-complete accreditation level compliance within 2years.

Treatment outcomes and esophageal cancer incidence by disease type in achalasia patients undergoing peroral endoscopic myotomy: Retrospective study.

This retrospective study aimed to compare treatment outcomes and postoperative courses, including the incidence of esophageal cancer (EC), according to disease types, in 450 achalasia patients who underwent peroral endoscopic myotomy (POEM). Data from consecutive POEM procedures performed from September 2011 to January 2023 at a single institution were reviewed. Achalasia was classified into straight (St), sigmoid (S1), and advanced sigmoid (S2) types using esophagography findings. Regarding efficacy, POEM was considered successful if the Eckardt score was ≤3. A statistical examination of the incidence and trend of EC occurrence across the disease type of achalasia was conducted using propensity score matching. Of the 450 patients, 349 were diagnosed with St, 80 with S1, and 21 with S2. POEM efficacy was 97.9% at 1 year and 94.2% at 2 years postprocedure, with no statistical difference between disease types. Using propensity score matching, the incidence of EC in each disease type was as follows: St, 1% (1/98); S1, 2.5% (2/77); S2, 10% (2/18). While no statistical significance was observed between St (1.0%: 1/98) and all sigmoid types (4.0%, 4/95; P = 0.3686). However, a trend test revealed a tendency for EC to occur more frequently in the order of S2, S1, and St type with a statistically significant difference (P = 0.0413). Outcomes of POEM are favorable for all disease types. After POEM, it is important not only to monitor the improvement of achalasia symptoms but also to pay attention to the occurrence of EC, especially in patients with sigmoid-type achalasia.

External Validation of a Commercial Artificial Intelligence Algorithm on a Diverse Population for Detection of False Negative Breast Cancers.

There are limited data on the application of artificial intelligence (AI) on nonenriched, real-world screening mammograms. This work aims to evaluate the ability of AI to detect false negative cancers not detected at the time of screening when reviewed by the radiologist alone. A commercially available AI algorithm was retrospectively applied to patients undergoing screening full-field digital mammography (FFDM) or digital breast tomosynthesis (DBT) at a single institution from 2010 to 2019. Ground truth was established based on 1-year follow-up data. Descriptive statistics were performed with attention focused on AI detection of false negative cancers within these subsets. A total of 26 694 FFDM and 3183 DBT examinations were analyzed. Artificial intelligence was able to detect 7/13 false negative cancers (54%) in the FFDM cohort and 4/10 (40%) in the DBT cohort on the preceding screening mammogram that was interpreted as negative by the radiologist. Of these, 4 in the FFDM cohort and 4 in the DBT cohort were identified in breast densities of C or greater. False negative cancers detected by AI were predominantly luminal A invasive malignancies (9/11, 82%). Artificial intelligence was able to detect these false negative cancers a median time of 272 days sooner in the FFDM cohort and 248 days sooner in the DBT cohort compared to the radiologist. Artificial intelligence was able to detect cancers at the time of screening that were missed by the radiologist. Prospective studies are needed to evaluate the synergy of AI and the radiologist in real-world settings, especially on DBT examinations.

Flexible reamer use to overcome entry point errors in proximal femoral nail application in severe obese intertrochanteric fracture patients

IntroductionProximal femoral nailing (PFN) offers biomechanical benefits for intertrochanteric fractures but can lead to higher complication rates from poor reduction and technique errors, particularly in obese patients. Incorrect entry points may cause reduction loss, iatrogenic fractures, and misplaced lag screws. The study aims to investigate the effect of using an oriented flexible reamer instead of a rigid reamer on clinical and radiological results to obtain a medial entry point and better positioning of the nail in the intramedullary area in obese intertrochanteric fracture patients.Materials and methodsA retrospective analysis was conducted on patients aged 65 years and older who underwent PFN treatment between March 2020 and June 2022 at a single institution, with at least 1-year postoperative follow-up. Patients were divided into two groups: those applied with a flexible reamer and a rigid reamer. Parameters analyzed from postoperative radiographs included tip-apex distance (TAD), calcar-referenced tip-apex distance (CalTAD), reduction quality, femoral neck-shaft angle, and lag screw placement. Complication rates and types were recorded for each group.ResultThe analysis included 91 patients, with 45 treated using a flexible reamer and 46 treated using a rigid reamer. There was no statistical difference between the two groups regarding age, gender, BMI, and AO class distributions of the patients (p > 0.05). The Femur neck shaft angle was significantly higher in the flexible reamer group (p < 0.001). As a result of the reduction types analysis, medial type reduction was significantly higher in the group where the flexible reamer was applied (p < 0.001). The CalTAD was shorter in the Flexible reamer group (p = 0.005). Complications and the need for reoperation were statistically significantly higher in the rigid reamer group (p < 0.048).ConclusionThe oriented flexible reamer reduces application-related errors in patients undergoing proximal femoral nail (PFN) treatment due to intertrochanteric fracture. The oriented flexible reamer technique allows a more medial entry point. Oriented flexible reamer creates enough space on both fracture sides at the level of intertrochanteric fracture to avoid nail pass-related complications.Level of evidenceLevel III, Case-control study.

The Operative Efficacy of Decompression and Fixation Surgery for Degenerative Lumbosacral Spondylolisthesis: A Single Institutional Study

The Operative Efficacy of Decompression and Fixation Surgery for Degenerative Lumbosacral Spondylolisthesis: A Single Institutional Study

Minimally Invasive Enucleation of Esophageal Leiomyoma: Experience From a Single Institution

Minimally Invasive Enucleation of Esophageal Leiomyoma: Experience From a Single Institution

Incidence and risk factors of post-stroke seizure among ischemic stroke patients

BackgroundPost-stroke seizure (PSS) increases morbidity and mortality after ischemic stroke, but a comprehensive understanding of its incidence and risk factors is lacking. We report the rate and risk factors of PSS at a single institution. MethodsA retrospective cohort study of adult acute ischemic stroke patients between 2018 and 2022 at a comprehensive stroke center was conducted. Patients with a history of seizures, additional stroke during index admission, or death within 7 days of stroke onset were excluded. Early PSS was defined as a new seizure occurring ≤7 days after stroke onset, while late PSS occurred >7 days after stroke onset. Multivariable logistic regression and cox proportional hazard analysis was conducted. Results1211 participants met inclusion criteria. Patients were a mean age of 67.82 and were primarily male (58.7 %), white (72.6 %), and non-Hispanic (91.9 %). Incidence of PSS was 8.8 % (n = 106), of which 53.8 % (n = 57) were early and 46.2 % (n = 49) were late. Bivariate analysis identified younger age, diabetes, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early Computed Tomography Score ≤5, cortical involvement, and hemorrhagic transformation as significant in the development of PSS. Multivariable cox proportional hazard analysis identified cortical involvement (hazard ratio [HR]: 2.31, 95 % confidence interval [CI] [1,29, 4.14]), NIHSS ≥ 21 (HR: 1.82, 95 % CI [1.02, 3.22]),and younger age (HR: 0.97, 95 % CI [0.96, 0.98]) as significant PSS predictors. ConclusionPSS occurred in 8.8 % of patients presenting with ischemic stroke. Hemorrhagic transformation, cortical involvement, high NIHSS, and younger age were significant predictors of PSS.

Time-Driven, Activity-Based Cost Analysis of Pars Plana Vitrectomy in Rhegmatogenous Retinal Detachment at a Large Academic Center

Purpose: To perform a time-driven, activity-based cost analysis of retinal detachment (RD) surgery and compare it with reimbursement rates. Methods: This economic analysis at a single academic institution used time-driven, activity-based costing methodology to determine the cost of rhegmatogenous RD repair with primary pars plana vitrectomy. A process flow map was created to highlight each surgical case’s operative episodes, including clinical follow-ups. Time logs were obtained from the electronic health record for each operative phase and clinical follow-up. The overhead and anesthesia costs were collected from the institution’s cost accounting system. The direct material and personnel costs were obtained from internal financial data. Results: Seventy-six cases that met the inclusion criteria were included in the cost analysis study. The time-driven, activity-based cost of RD was $6247.17, and the reimbursement was $5442.91. Therefore, each procedure had a net negative loss of $804.26. To break even, the average operation time would need to be reduced from the determined average of 90.49 minutes to 64.90 minutes. Conclusions: This study found that Medicare underestimates the true cost of RD surgery. Changes in referral patterns may be motivated by reimbursement rates lower than the cost of the procedure, which could ultimately affect patient access to care.

Adjustment of stem anteversion using tapered cone stem in total hip arthroplasty.

The aim of this study was to evaluate the suitability of the tapered cone stem in total hip arthroplasty (THA) in patients with excessive femoral anteversion and after femoral osteotomy. We included patients who underwent THA using Wagner Cone due to proximal femur anatomical abnormalities between August 2014 and January 2019 at a single institution. We investigated implant survival time using the endpoint of dislocation and revision, and compared the prevalence of prosthetic impingements between the Wagner Cone, a tapered cone stem, and the Taperloc, a tapered wedge stem, through simulation. We also collected Oxford Hip Score (OHS), visual analogue scale (VAS) satisfaction, and VAS pain by postal survey in August 2023 and explored variables associated with those scores. Of the 58 patients (62 hips), two (two hips) presented with dislocation or reoperation, and Kaplan-Meier analysis indicated a five-year survival rate of 96.7% (95% CI 92.4 to 100). Mean stem anteversion was 35.2° (SD 18.2°) for the Taperloc stem and 29.8° (SD 7.9°) for the Wagner Cone stem; mean reduction from Taperloc to Wagner Cone was 5.4° (SD 18.8°). Overall, 55 hips (52 patients) were simulated, and the prevalence of prosthetic impingement was lower for the Wagner Cone (5.5%, 3/55) compared with the Taperloc (20.0%, 11/55) stem, with an odds ratio of 0.20 (p = 0.038). Among the 33 respondents to the postal survey (36 hips), the mean scores were VAS pain 10.9, VAS satisfaction 86.9, and OHS 44.7. A multivariable analysis revealed that reduction of stem anteversion from Taperloc to Wagner Cone was more favourable for VAS pain (p = 0.029) and VAS satisfaction (p = 0.002). The mid-term survival rate for THA using the Wagner Cone stem was high, which may be supported by a reduction in prosthetic impingement. The reduction in excessive stem anteversion by using a tapered cone stem was associated with reduced pain and increased patient satisfaction.

Safety and effectiveness of Neuroform Atlas stent-assisted coil embolization for ruptured intracranial aneurysms.

The treatment outcomes of ruptured intracranial aneurysms using the Neuroform Atlas stent were evaluated. This study represents a retrospective review that included patients who underwent endovascular treatment for ruptured aneurysms at a single institution. Between January 2018 and September 2022, endovascular treatments including simple coiling or Neuroform Atlas stent-assisted coil embolization were performed in 191 patients with ruptured intracranial aneurysms. Intraprocedural rupture was observed in 11 (8.7%) patients in the Simple Coiling (SC) group, which was slightly higher than that in 4 (6.3%) patients in the Neuroform Atlas stent-assisted coiling (NASAC) group (p=0.241). However, Thromboembolic event (TEE) was slightly more prevalent in the NASAC group, with 4 (6.3%) cases as compared to the 5 (3.9%) cases in the SC group (p=0.235). The retreatment rate was slightly higher in the SC group, with 19 (26.4%) patients as compared to the 10 patients (22.2%) in the NASAC group (p=0.342). The use of the Neuroform Atlas stent (NAS) for ruptured aneurysms might be safe and effective.

High dose chemotherapy with autologous stem cell rescue in children and young adults with high-risk Ewing sarcoma: A single institute experience in Taiwan.

A combination treatment of surgery, chemotherapy, and radiotherapy can improve the survivals of pediatric patients with Ewing sarcoma (ES). However, prognosis remains poor for patients with metastatic disease at diagnosis or recurrence. Other high-risk (HR) features include large tumor burden, tumors of the axial skeleton and poor histologic response. Several studies have documented high dose chemotherapy with autologous stem cell rescue (HDC-ASCR) to be effective in such patients. In this retrospective study, we present the results of HDC-ASCR for high-risk Ewing sarcoma in children and young adults in a single institute. From March 2004 to March 2021, patients with ES, Ewing-like sarcoma, or round cell sarcoma received HDC-ASCR as part of treatment were included. The patients' characteristics, disease status, stem cell dose, engraftment status, post-transplant complications, and outcomes were analyzed. Twenty patients receiving HDC-ASCR at complete response (n = 6), partial response (n = 13), and stable disease (n = 1) were enrolled. The male to female ratio was 11:9. Median age at diagnosis and transplant was 15.6 years old (range: 3.3-28.9) and 16.2 (range: 4.2-29.9), respectively. The conditioning regimens included ifosfamide-based in two and melphalan-based in 19. All patients achieved successful engraftment without tansplant-related mortality. The 5-year progression-free and overall survival (OS) rate were 35% and 54.5%, respectively. The causes of death (n = 8) were all contributed to disease progression. Patients in the complete response group or with localized HRES exhibited a higher 5-year OS (p = 0.047 and 0.05, respectively). Compared to the historical cohort without HDC-ASCR as part of primary treatment, the current cohort had a significantly better 5-year OS (p = 0.018). HDC-ASCR seems promising as an alternative treatment for HRES in improving OS in this retrospective study with limited case number.

DOES CHANGE IN CORONAL PLANE ALIGNMENT OF THE KNEE CLASSIFICATION FOLLOWING TOTAL KNEE ARTHROPLASTY INFLUENCE PATIENT-REPORTED OUTCOMES AND SURVIVORSHIP? A REVIEW OF 1,062 CASES WITH TEN YEARS’ FOLLOW-UP

Restoration of native Coronal Plane Alignment of the Knee (CPAK) phenotype is a strategy suggested to achieve better satisfaction. The aim of this study was to investigate the influence of changes in CPAK classification on patient-reported outcome measures (PROMs) and survivorship in a large cohort of manual mechanically aligned (MA) cemented TKAs.A retrospective analysis of 1062 consecutive cemented TKAs using MA philosophy at a single institution. Pre- and post-operative hip-knee-ankle radiographs were classified using the CPAK classification. Oxford Knee Score (OKS) and patient satisfaction (4-point-Likert scale) were collected prospectively. Implant survival data was obtained from our national arthroplasty database. We compared the outcomes of patients who maintained or changed their CPAK classification following TKA. Satisfaction was analysed using chi-square test, and OKS was analysed using Mann-Whitney test.Pre-operatively, most patients were CPAK type-I (38.8%). 85.5% of patients changed their CPAK type post-operatively, with CPAK type-V observed in 41.2% of these. Significantly better satisfaction (p=0.033) and OKS (p=0.021) were observed at one-year follow-up in patients who changed CPAK type, although the difference was below OKS minimally important clinical difference. There was no difference in satisfaction (p=0.73) and OKS (p=0.26) at one year between CPAK-V and non-V classifications. Post-operative CPAK type had no correlation with satisfaction and OKS. 12 TKAs (1.1%) were revised within 10 years (3 septic).In this large cohort of MA-TKA, excellent survivorship was observed at 10 years, with no demonstrable difference in outcome related to the final CPAK phenotype or change in phenotype.

A comment on: “Survival-Effective prognostic factors of rectal cancer patients receiving neoadjuvant chemoradiotherapy.”

Dear Editor, I would like to share my opinion on the article titled "Survival-effective Prognostic Factors of Rectal Cancer Patients Receiving Neoadjuvant Chemoradiotherapy," published in the Cerasus Medical Journal, Volume 1, Issue 2, pages 117-123, on June 14, 2024. The article was authored by Orhun Uzun et al [1]. Firstly, I want to thank the authors for their contribution to the field. The study's objective was clear: to identify survival-effective prognostic factors in this patient population. As mentioned by the researchers, they utilized a retrospective review of 102 patients who underwent surgery for rectal cancer at a single institution, ultimately including 84 patients in the analysis after applying exclusion criteria. While the study’s objective is well-defined, its design and scope present certain limitations that affect the strength and applicability of its conclusions.

Normal saline injection and rapid rollover; preventive effect on incidence of pneumothorax after CT-guided lung biopsy: a retrospective cohort study

BackgroundComputed tomography (CT)-guided lung biopsy is a widely used technique for the diagnosis of pulmonary lesions and with a high technical success rate and diagnostic accuracy. On the other hand, it is associated with a high risk of complications, especially pneumothorax. Various methods have been tried to reduce the incidence of pneumothorax, but no established method exists. The purpose of this study was to evaluate whether the combination of tract sealing with normal saline and rapid rollover can reduce the rate of pneumothorax and chest tube insertion after CT-guided lung biopsy.MethodsWe reviewed all CT-guided lung biopsies performed at a single institution between October 2016 and December 2021. Before August 2019, no specific additional techniques were employed to mitigate complications (Group 1). In contrast, after September 2019, normal saline for tract sealing was injected during needle removal, and if pneumothorax was observed during the intervention, the patient was rolled over into the puncture-site down position immediately after needle removal (Group 2). The rate of complications was compared between the two groups.Results130 patients in Group 1 and 173 in Group 2 were evaluated. There was no significant difference in pneumothorax rate between the two groups (30.0% vs. 23.1%, P = .177). A chest tube was inserted in 10 of 130 patients in Group 1 and only in 1 of 173 in Group 2 (P = .001). There were no complications associated with this combinational technique.ConclusionsThe combination of normal saline injection and rapid rollover significantly reduced the incidence of pneumothorax requiring chest tube insertion after CT-guided lung biopsy. Therefore, normal saline injection and rapid rollover can serve as a preventive method for severe pneumothorax in CT-guided lung biopsy.