Sixth Postoperative Week Research Articles

Kisspeptin administration may promote precopulatory behavior in male rats independently or supplementally to testosterone and contribute to proceptive behavior in female partners, reducing mating failure

Kisspeptin is a peptide that plays an important role through its effects on the hypothalamus-pituitary–gonadal (HPG) axis. It has also been implicated in sexual behavior. The present study investigated whether the relationship between kisspeptin and sexual behavior is independent of the HPG axis, i.e., testosterone. Sexual behavior was examined after the administration of kisspeptin to gonadally intact male rats and gonadectomized male rats that received testosterone supplementation. Other male rats were also observed for sexual behavior once a week from 2 to 5 weeks after gonadectomy and receiving kisspeptin for the sixth postoperative week. Sexual behavior in female rats serving as the partner for each male was also observed. Female rats were not administered kisspeptin in the present study. The results obtained showed that the administration of kisspeptin increased precopulatory behavior in gonadally intact male rats and gonadectomized male rats that received testosterone supplementation and proceptive behavior in their female partners. Precopulatory behavior in males and receptive behavior in females increased, while copulatory behavior in males and receptive behavior in females remained unchanged. Furthermore, the administration of kisspeptin increased precopulatory behavior in gonadectomized males, but did not affect receptive behavior in females. These results suggest that kisspeptin affected males independently and/or supplementally to testosterone, and also that changes in the presence of testosterone in males had an impact on proceptive behavior in their female partners. In conclusion, kisspeptin may involve an as-yet-unidentified neural pathway in sexual desire independently of the HPG axis.

Accuracy of physical examination versus Doppler ultrasonography for determining maturity in postoperative arteriovenous fistula formation

Differentiating between arteriovenous fistula (AVF) maturation and failure can help determine which AVF will undergo successful canulation and which ones will require immediate rescue. A prospective observational study was conducted at Vajira Hospital in Bangkok, Thailand, between October 2020-November 2022. A single vascular surgeon performed a physical examination on patients with chronic kidney disease undergoing AVF placement, and a radiologist conducted Doppler ultrasonography during the second and sixth postoperative weeks. Dialysis nurses determined AVF maturity by performing cannulation. The study compared the accuracy of physical examination and Doppler ultrasonography. A model was developed to predict the success of AVF use. Out Of the 125 recruited patients, 81% demonstrate unassisted maturation of their AVF. The male sex and brachiocephalic type are associated with AVF maturation. The physical examination findings of palpable thrill and the absence of a strong pulse at the 6th week show an area under the receiver operating curve (AUC) value of 0.79. Similarly, arterial end-diastolic velocity on ultrasonography at the 6th week also demonstrates a comparable predictive value with an AUC of 0.82 (p=0.697). Meanwhile, the model that combined end-diastolic velocity and venous volume flow yields the best results for predicting AVF maturation, with an AUC of 0.92. These models provide more accurate predictions compared to physical examination alone (AUC: 0.92 vs. 0.79; p<0.01). Although a prudent physician predicts AVF maturation through a thorough physical examination, Doppler ultrasonography is preferred in anticipating the success of postoperative AVF placement.

Is Carpal Tunnel Release Necessary in High-Energy Distal Fractures of the Radius?

Purpose This study aimed to compare the clinical outcomes of patients who underwent volar plate osteosynthesis for high-energy distal radius fracture (DRFx) and carpal tunnel release (CTR) for acute or subacute carpal tunnel syndrome (CTS) with patients who did not undergo CTR. Methods This study is a retrospective evaluation of all high-energy DRFx treated with volar plate osteosynthesis in a regional hospital between January 2021 and January 2023. All adult patients (≥18 years) who underwent open reduction and internal fixation were included in the study after obtaining approval from the internal review board of our institution. Only patients who underwent plate osteosynthesis of the volar aspect through a modified Henry incision and patients who underwent CTR through a classic separate incision were included in the study. Clinical results includehand dynamometry, visual analog scale (VAS) scores, and physical examination findings of patients who underwent volar plate osteosynthesis because of high-energy DRFx and CTR due to CTS in the acute and subacute periods were retrospectively examined. Results Among the patients who underwent volar plate osteosynthesis because of high-energy DRFx, no statistically significant difference was detected between the hand grip strength and VAS scores of patients who underwent CTR because of acute CTS and subacute CTS at the sixth postoperative week (p>0.05). Conclusion Prophylactic CTR may be performed in the same session in selected cases, such as DRFx caused by a high-energy injury, to establish a scale for DRFx at a high risk of CTS and avoid delays in treatment. CTR for transient CTS detected in the subacute period during outpatient follow-up does not improve clinical outcomes.

Short-term Visual Outcome Following Anterior Chamber Intraocular Lens Implantation—The Experience of a Rural Teaching Hospital

Purpose: To report the indications, frequency and short-term visual outcome of anterior chamber intraocular lens implantation (ACIOL) in a rural tertiary hospital; as well as to describe the reasons for poor visual outcome following ACIOL implantation. Methods: This was a retrospective descriptive study of all patients aged at least 18 years who underwent cataract extraction and implantation of ACIOL between January 2004 and May 2023. Information retrieved from the case records included preoperative visual acuity, indication for ACIOL implantation, first-day postoperative visual acuity, and 6 weeks postoperative visual acuity. Results: A total of 133 eyes of 126 patients were reviewed in this study. The mean age was 60.9 years, with a male-to-female ratio of 1.7:1. The most common indication for ACIOL use was a posterior capsular rent (70.7%). The first-day postoperative visual acuity was 6/18 or better in 7 (5.3%) patients, and by the sixth postoperative week, this proportion had increased to 28.6% (38 patients). The most common complication on the first day post-op was striate keratopathy (72.9%), while the most common at 6 weeks was pseudophakic bullous keratopathy (21.1%). Conclusion: Although complications were noted with the use of ACIOLs, improvement in visual acuity was observed at 6 weeks. ACIOLs may still be relevant in settings where automated vitrectomy equipment is not readily available, but the availability of expertize is required for its implantation and the complication profile of ACIOLs must always be taken into consideration.

Identification of the damage mechanism in orthopaedic implant. Case study including the biomechanical analysis

Implant breaking destabilizing the fracture may be caused by its structural defect, inappropriate use, or massive overloads. We present the patient, who broke the plate stabilizing comminuted clavicular fracture at the sixth postoperative week due to the, primarily reported, simple loading of the limb that should not exceeded admissible limits. Macroscopic examination excluded its manufacturing defect of an explant, but revealed areas of fatigue fractures, as well as anterior and inferior bending of its edges. Mechanical analysis proved sufficient material durability. Those findings clearly showed that the plate broke in consequence of repetitive overloads exceeding its durability. Patient, when acquitted with those results, confessed that the plate broke, while fishing. Moreover, he reported an episode of alcohol overuse that could contribute to implant failure bringing the risk of additional injury. Biomechanical analysis confirmed that mechanical loads throwing the spinner exceed values adequate for plate breaking. Thus, the real circumstances of the complication seem to be unveiled pointing out to facts that some patients disobey postoperative recommendations to avoid overloading of stabilized extremity, thus participating actively in this type of complications, that they dissemble the real circumstances of the complications, and that they may exhibit risky and irrational behavior. Basing on the presented case we concluded that in some cases plaster cast immobilization supporting stabilized fracture may be beneficial precluding banned activities and preventing from secondary injuries reducing the risk of postoperative complications.

Vitamin D3 and omega-3 polyunsaturated fatty acids have beneficial effects on fracture union in an experimental rat model.

This study aimed to determine the influences of vitamin D3 and omega-3 polyunsaturated fatty acids (PUFAs) on fracture union in rats radiologically, histologically, and biomechanically. Forty-eight male Sprague-Dawley rats (mean weight: 435±31.15 g; range, 398 to 510 g) were indiscriminately separated into four groups, with 12 rats in each: Group 1 was the control group, Group 2 received vitamin D3, Group 3 received omega-3 PUFA, and Group 4 received both vitamin D3 and omega-3 PUFA. One day after surgery, only one intramuscular dose of 50,000 IU/kg vitamin D3 was administered to Group 2. From the first postoperative day until sacrification, 300 mg/kg omega-3 PUFA by oral feeding was administered to Group 3. In Group 4, both an intramuscular dose of 50,000 IU/kg vitamin D3 on the initial postoperative day and 300 mg/kg omega-3 PUFA were administered by oral feeding until sacrification. All rats were sacrificed by intracardiac potassium injection at the sixth postoperative week, and radiological, biomechanical, and histological studies were conducted. According to the radiological scores, the best scores were obtained in Group 4, and callus density and ossification were advanced in Groups 2 and 3 compared to Group 1. There was no statistically significant distinction between Groups 3 and 4, while a significant distinction was found between Group 4 and Groups 1 and 2. Biomechanically, the advanced values were attained in Groups 1 and 3. However, there was no statistically significant distinction among the groups. Histologically, although the advanced scores were attained in Groups 3 and 4, there was no statistically significant distinction among the groups. The use of omega-3 PUFA together with vitamin D3 might have beneficial influences on fracture union. In the future, the combination of omega-3 PUFA and vitamin D3 might be used as an encouraging treatment choice that contributes to fracture healing.

Does Time to Initiation of Adjuvant Radiotherapy Affect Reconstruction Outcomes after Endoscopic Resection of Skull Base Malignancies?

Introduction and Objective It is unclear if the length of the time interval to initiation of adjuvant radiation therapy (RT) after endoscopic endonasal surgery affects reconstruction outcomes. In this study we present our experience with adjuvant RT after endoscopic endonasal procedures, to determine if the time to RT after surgery impacts post-RT reconstruction complication rates. Methods A retrospective cohort study of 164 patients who underwent endoscopic endonasal surgery between 1998 and 2021 was conducted. Using Cox proportional hazard ratios (HRs), we evaluated several variables and the complications that occurred during the 1-year period after starting RT. Results Seventy-eight (47.5%) and eighty-six patients (52.5%) received RT before and after the sixth postoperative week, respectively. The overall post-RT complication rates were 28%, most of these were severe infections ( n = 20, 12.2%) and delayed CSF leak ( n = 4, 2.5%). There was no significant difference in the post-RT complications between the patients who received postoperative RT before or after the sixth operative week (HR: 1.13; 95% confidence interval: 0.63-2.02; p = 0.675 ). Univariate analysis demonstrated negative impact associated with smoking history ( p = 0.015 ), the use of neoadjuvant chemotherapy ( p = 0.0001 ), and the use of photon therapy ( p = 0.012 ); and we found a positive impact with the use of multilayer reconstruction techniques (overall, p = 0.041 ; with fat, p = 0.038 ; and/or fascia graft, p = 0.035 ). After a multivariate analysis only, smoking history was an independent risk factor for post-RT complications ( p = 0.012 ). Conclusion Delaying RT for more than 6 weeks after endoscopic endonasal surgery does not provide a significant benefit for reconstruction outcomes. However, special attention may be warranted in patients with smoking history who have received neoadjuvant chemotherapy, or in patients who will receive photon-based RT after surgery as these groups were found to have increased complication rates post-RT.

Intraocular pressure changes following small-incision cataract surgeries in a tertiary care center: a prospective study

Aim This study aims to identify the pattern of intraocular pressure (IOP) changes after uneventful small-incision cataract surgery (SICS) in previously normotensive eyes, to know the cause for these postoperative changes, and to correlate the preoperative anterior chamber depth (ACD) to the postoperative IOP change. Patients and methods A prospective study was conducted at Yenepoya Medical College, Mangalore, India on 87 non-glaucomatous eyes that underwent an uneventful SICS with posterior chamber intraocular lens implantation. The IOP was measured preoperatively and postoperatively on days 1, 3, and weeks 1, 3, and 6. We tried to identify the cause of the IOP change. The preoperative and postoperative ACD change was also noted and correlated with the IOP change. Results The mean preoperative IOP was 14±1.81 mm Hg. On the first postoperative day (POD-1), 54% of the eyes showed a statistically significant rise in IOP (mean IOP=17.03±7.17 mm Hg, P=0.0002), and 28% showed a mean fall in IOP of 9.28 mm Hg. On the third postoperative day (POD-3), the IOP showed a statistically significant rise (14.82±3.93 mm Hg, P=0.028) compared with the preoperative value. At the end of the first postoperative week (POW-1), the IOP showed a statistically nonsignificant rise (P=0.66). By the third postoperative week (POW-3), the IOP decreased to 13.82±2.83 mm Hg, with a statistically nonsignificant difference compared with the preoperative IOP (P=0.45). However, there was a statistically significant decrease in the IOP (P=0.0001) in the sixth postoperative week (POW-6). Postoperatively, there was a statistically significant increase in ACD from 3.01±0.31 to 3.23±0.36 mm (P=0.0001) by the POW-3. The preoperative ACD showed a statistically significant moderate negative correlation with late postoperative IOP (r=−0.7394, P&lt;0.0001). Conclusion After SICS, at the end of 6 weeks, there was a statistically significant decrease in the mean IOP with an increase in the ACD. A moderate negative correlation existed between the preoperative ACD and late postoperative IOP. It was found that 2.3% of the eyes were steroid responders and showed a rise in IOP at POW-3.

Association of COVID-19 Lockdown With Increased Rate of Cyclops Syndrome in Patients With Unexpected Home-Based Self-Guided Rehabilitation After ACL Reconstruction.

The risk of cyclops syndrome increases significantly after anterior cruciate ligament (ACL) reconstruction (ACLR) if complete extension is not recovered before the sixth postoperative week. The lockdown in France due to the COVID-19 pandemic led to an absence of supervised rehabilitation, requiring unexpected self-rehabilitation in patients who underwent ACLR just before lockdown. To determine the rate of cyclops syndrome after ACLR in patients who underwent self-rehabilitation during lockdown. Cohort study; Level of evidence, 3. A total of 75 patients receiving a hamstring graft for ACLR during the COVID-19 pandemic between February 10, 2022, and March 16, 2020, carried out self-rehabilitation during part of their first 6 postoperative weeks using exercise videos on a dedicated website. Clinical examination was performed at a minimum 1-year follow-up with International Knee Documentation Committee (IKDC), Lysholm, Tegner, and ACL-Return to Sport after Injury (ACL-RSI) scores. This group was compared with a matched-pair control group of 72 patients who underwent surgery in 2019 and completed postoperative supervised rehabilitation with a physical therapist. Rates and reasons for second surgery (arthrolysis, meniscal procedure) were also recorded. In the COVID group (n = 72; 3 patients were lost to follow-up), the mean follow-up was 14.5 ± 2.1 months (range, 13-21) and rate of reoperation for clinical cyclops syndrome was 11.1% (n = 8). The rate of cyclops syndrome was significantly lower (1.4%) in the control group (P = .01). In the COVID group, 8 patients underwent anterior arthrolysis at a mean of 8.6 months after the primary surgery, and 4 patients underwent another surgical intervention (meniscal procedure [n = 3], device removal [n = 1]). In the COVID group, mean Lysholm was 86.6 ± 14.1 (range, 38-100), Tegner was 5.6 ± 2.3 (range, 1-10), subjective IKDC was 80.3 ± 14.7 (range, 32-100) and ACL-RSI score was 77.3 ± 19.7 (range, 33-100). The rate of cyclops syndrome after ACLR was significantly greater in the COVID group versus the matched controls. The dedicated website was not effective at supporting self-guided rehabilitation and could benefit from interactive improvements so it is at least as effective as supervised rehabilitation.

Evaluation of Masticatory Forces in Patients Treated for Mandibular Fractures: A Case-Control Study.

Purpose:​​​​​ This study aimed to evaluate the masticatory forces in patients treated for mandibular fractures. To assess the magnitude of damage to the masticatory system caused by the various mandibular fractures and the period required for their normalization.Materials and Methods: Data were recorded from the authentic and original bite force measurement device from 2015 to 2017. The sample was composed of 30 isolated mandible fractures patients, Group 1 consisting 15 patients with unilateral mandible fractures, Group 2 consisting 15 patients with bilateral mandible fractures, treated with ORIF (open reduction immobilization fixation) under general anesthesia, and Group 3 was a control group. Predictor variables were drawn from predefined intervals for three months (ninth POW) postoperative week.The condition of wound healing was checked, and masticatory forces are measured at the first, fourth, sixth, and ninth postoperative weeks and compared with a control group of the same age and gender. The outcome variables were the success rate and associated complications.Results: For the study, a total of 30 patients with 15 bilateral and 15 unilateral isolated mandibular fractures were included. The study result suggests that the patient had lower bite forces relative to the control group at all intervals. All patients showed a significant increase in the bite force values from the first to the fourth postoperative weeks (p = ‹0.001), which also increased significantly from the fourth to sixth postoperative weeks (p = ‹0.001), and from the sixth to the ninth week. Conclusion: ​​​​ Based on the results obtained from our study, we conclude that there is a temporary adverse effect on masticatory forces. Fracture of the bilateral mandible has a stronger influence on bite force than unilateral mandible fracture. These fractures also take a longer time to normalize.

Clinical and Radiological Outcomes of Closed-Loop, Double Button, Coracoclavicular Fixation for Extralateral (Neer Type IIC) Fractures of the Distal Clavicle.

Background: The distal end of the clavicle accounts for 10-28% of all clavicle fractures of which 52.8% are considered displaced and require internal fixation due to their high percentage of non-union. Numerous surgical techniques have been described for the well-known Neer types IIA, IIB, and V. Still, the literature is scarce for the rare “extralateral” (type IIC) fracture where the fracture line is located lateral to the completely torn coracoclavicular (CC) ligaments; such small fractures are sometimes not amenable for standard locking plate fixation.Methods: We present a series of seven patients treated surgically with closed-looped double button CC stabilization via an open approach. There were four males and three females with a mean age of 31 years (range: 19-46 years). The mechanism of injury was a motor vehicle accident in four cases and a fall from height in three cases. The average time from injury to surgery was 2.7 ± 1.3 days and the average follow-up period was 25.7 months (range: 16-48 months). A custom-made, closed-looped, double button device was made using the ProCinch Adjustable Cortical Fixation for anterior cruciate ligament (ACL) (Stryker, Kalamazoo, Michigan) and another standard or slotted button. The fracture was reduced anatomically and the device was tightened and secured with five to six knots. In two cases, additional interfragmentary sutures were used for extra stability. Postoperatively, the arm was immobilized in a simple sling for four weeks; passive assisted elevation up to 90 degrees was allowed from the second postoperative week, followed by active elevation after the sixth postoperative week. Radiological outcomes (bony union, loss of reduction, implant mispositioning, or subsidence of buttons) were assessed using serial plain radiographs. The Constant score (CS) and the Acromioclavicular Joint Instability Score (AJIS) were used for the final clinical evaluation, at least one year postoperatively.Results: Bony union was achieved in all patients at a mean time of 2.7 months (range: 2.5-3.6 months). No cases of delayed union, loss of reduction, button migration, or subsidence were noted. The mean CS was 96.6 ± 3.4 and the mean AJIS score was 94.1 ± 4.7 in a mean follow-up period of 25.7 months (range: 16-48 months). One patient developed a hypertrophic scar and another had mild skin irritation by the suture knots; no other complications were noted except for one patient who developed an early superficial skin infection managed with antibiotics and debridement under local anesthesia. Four patients who participated in sports before injury were able to regain almost full activity seven to nine months after the operation. All were satisfied with the final result. Two patients showed ossification of the CC ligaments with no significant clinical implications.Conclusions: Although we retrospectively reviewed a small series of patients, we were able to demonstrate a complete rate of fracture union and excellent clinical outcomes with no major complications. Type IIC distal clavicle fractures are rare and require special attention in terms of reduction and optimal fixation. Open CC fixation with closed-looped double buttons is a relatively easy and reproducible technique. We advocate the readjustment of Neer’s classification, including “extralateral” fractures as a IIC subtype.

Ultra-minimally Invasive Sonographically-guided Trigger Digit Release: An External Pilot Study.

ObjectivesThe most common surgical option for releasing the first annular pulley in trigger digit (TD) is classic open surgery followed by blind percutaneous release. However, they have been related to major complications and incomplete releases, respectively. Intrasheath sonographically-guided first annular pulley release has recently been shown to be safe and effective in every digit. The objectives of this pilot study were to preliminary compare clinically an intrasheath sonographically-guided first annular pulley release versus a classic open technique and to evaluate the feasibility of a future clinical trial in patients with TDs.MethodsThirty patients were randomized 1:1 in an external pilot study comparing the two surgical techniques: a percutaneous sonographically-guided release performed through a 1 mm incision using a hook knife versus a classic open surgery with a 1 cm incision. Inclusion criteria were primary TD grade III (Froimson). We defined success if primary (safety and efficacy) and secondary (recruitment rates, compliance, completion, treatment blinding, personnel resources, and sample size calculation for the clinical trial) objectives could be matched. We registered the grip strength, the QuickDASH score and a set of postoperative clinical variables at one, three, and six weeks and at three months. We calculated the sample size for the clinical trial using the QuickDASH at the end of the follow-up. Outcomes assessors were blinded.ResultsAll patients in both groups showed resolution of their symptoms with no associated complications or relapses. Secondary feasibility objectives were matched: 76.9% of eligible patients were included in the study, 3.3% refused randomization, 20 patients per month were recruited, 100% received blinded treatment, 98.5% showed compliance, and 100% completed the study. The sample size for a future clinical trial was 84 patients. There were no differences in grip strength. The intrasheath sonographically-guided first annular pulley release showed significantly better QuickDASH scores, until the sixth postoperative week.ConclusionsThe intrasheath sonographically-guided first annular pulley release is safe and efficacious, and shows a trend toward clinical superiority versus the classic open procedure, which should be confirmed with a clinical trial. Our study shows that a randomized clinical trial is feasible.

Supracutaneous locking compression plating for the management of humerus fracture in a dog

A dog was presented to the University Veterinary Hospital, Kokkalai with a history of nonweight bearing lameness on left forelimb and was diagnosed as humerus fracture. Supracutaneous locking compression plating was carried out after open reduction under general anaesthesia. Periodic clinical and radiographic evaluations were conducted at two weeks interval for a period of six weeks until the plate removal. Physiological and haematological parameters were within the normal range. The serum alkaline phosphatase level was high at the time of presentation and decreased progressively. The dog returned to sound gait, normal weight bearing and satisfactory functional limb usage by sixth post operative week. The fracture healed with periosteal and endosteal callus. The implant was intact and patient acceptance was satisfactory throughout the observation period.

Meniscal Suture Influence on Driving Ability 6 Weeks after Anterior Cruciate Ligament Reconstruction with Hamstring Autograft.

The purpose of this study was to determine if driving ability 6 weeks after anterior cruciate ligament (ACL) reconstruction is affected by the addition of a meniscal suture. It was also hypothesized that no differences in the driving performance would be found between right or left knee surgery subgroups. A total of 82 people participated in this prospective cohort study: 36 healthy controls, 26 patients undergoing isolated ACL (iACL) reconstruction with hamstring autograft, and 20 patients undergoing ACL and meniscal suture (ACL-MS) reconstruction. ACL-MS group followed a weight-bearing and movement restriction protocol during the first 2 postoperative weeks, whereas patients undergoing iACL could start range-of-motion exercises and full weight-bearing ambulation on the first postoperative day. A driving simulator that reproduced real-life driving conditions was used to evaluate driving ability. The software analyzed multiple driving and braking variables. Driving performance in the sixth postoperative week was compared with that of a healthy control group. Subgroup analysis considering additional procedures (iACL, ACL-MS) and the side of the operated knee (right, left) was also performed. No statistically significant differences were found in the demographic characteristics nor in the driving performance (collisions, p = 0.897; sidewalk invasions, p = 0.749; pedestrian impact, p = 0.983) between iACL, ACL-MS, and control groups. No statistically significant differences were found in right-left subgroup analysis. The results of the present study show that patients in their sixth postoperative week after right or left ACL reconstruction showed similar driving performance as compared with a healthy control group, regardless of associating or not a meniscal suture, suggesting it is safe to resume driving 6 weeks after the mentioned surgeries.

Comparison of the Effectiveness of Three Lumbosacral Orthoses on Early Spine Surgery Patients: A Prospective Cohort Study.

ObjectiveTo compare the convenience and effectiveness of the existing lumbosacral orthoses (LSO) (classic LSO and Cybertech) and a newly developed LSO (V-LSO) by analyzing postoperative data.MethodsThis prospective cohort study was performed from May 2019 to November 2019 and enrolled and analyzed 88 patients with degenerative lumbar spine disease scheduled for elective lumbar surgery. Three types of LSO that were provided according to the time of patient registration were applied for 6 weeks. Patients were randomized into the classic LSO group (n=31), Cybertech group (n=26), and V-LSO group (n=31). All patients were assessed using the Oswestry Disability Index (ODI) preoperatively and underwent plain lumbar radiography (anteroposterior and lateral views) 10 days postoperatively. Lumbar lordosis (LS angle) and frontal imbalance were measured with and without LSO. At the sixth postoperative week, a follow-up assessment with the ODI and orthosis questionnaire was conducted.ResultsNo significant differences were found among the three groups in terms of the LS angle, frontal imbalance, ODI, and orthosis questionnaire results. When the change in the LS angle and frontal imbalance toward the reference value was defined as a positive change with and without LSO, the rate of positive change was significantly different in the V-LSO group (LS angle: 41.94% vs. 61.54% vs. 83.87%; p=0.003).ConclusionThe newly developed LSO showed no difference regarding its effectiveness and compliance when compared with the existing LSO, but it was more effective in correcting lumbar lordosis.

Effect of low-level laser therapy on the membrane induced by the Masquelet technique at an orthotopic site in rabbits.

ABSTRACTPurpose:To evaluate the low-level laser therapy (LLLT) on the membrane induced by the Masquelet technique in rabbits.Methods:Twelve Norfolk rabbits at approximately 3 months of age were used. A 1-cm segmental defect was induced in both radii, which were filled with polymethylmethacrylate cylinder. LLLT was used postoperatively in the bone defect of one of the forelimbs every 48 hours for 15 days. Six rabbits were euthanatized on third and sixth postoperative weeks.Results:In both forelimbs, radiographs showed new bone growth from radius cut ends on the third postoperative week and more advanced stage on the sixth postoperative week. Ultrasound showed induced membrane one week after the surgery. Histologically, there were no significant differences in the semi-quantitative score of inflammation intensity, total number of blood vessels, bone metaplasia, and collagen. The average thicknesses were 2,050.17 and 1,451.96 μm for control membranes and 2,724.26 and 2,081.03 μm for irradiated membranes, respectively, on third and sixth postoperative weeks. Vascular endothelial growth factor A (VEGF-A) and platelet derived growth factor (PDGF) expression were present in the induced membranes of control and irradiated forelimbs, but there was no significant difference.Conclusions:Based on assessment methods, it was not possible to demonstrate the effect of LLLT on the induced membrane.

Adjunctive postoperative course of dexamethasone in chronic subdural hematoma: Effect on surgical outcome.

Objectives:To compare the effect of burrhole craniostomy with and without a postoperative course of dexamethasone on recurrence rate of chronic subdural hematoma (CSDH).Methods:The study was conducted at the Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, from September 2017 till May 2018. Adult patients diagnosed with CSDH and advised burrhole craniostomy were enrolled in this prospective randomized controlled trial. Participants were randomized into Group-1 (receiving two weeks dexamethasone), and Group-2 (no dexamethasone). Clinical assessment and Brain CT were done preoperatively, second postoperative day, sixth and twelfth postoperative week, with outcome assessed at twelfth postoperative week. Complications of treatment and recurrence rate were recorded.Results:Ninety-two (n=92, 46 in each group) patients were enrolled. Improvement in neurological (95.7% vs 93.5%; P=0.646) and radiological outcome (95.7% vs 93.5%; P=0.646) was similar in both groups. Complication rate was higher in Group-1 but not significantly different (58.7% vs 43.5%; P=0.535). Most frequent complication was pneumocephalus, with mortality rate equal (n=one). Recurrence was observed in 2.2% (n=1/46) patients in Group-1 and 4.3% (n=2/46) in Group-2 (P=0.557), which was not statistically significant.Conclusions:Neurological and radiological outcome, and mortality rates were similar in both groups. The recurrence rate was lower and complications slightly higher in Group-1 but these were not statistically significant.

The Effects of Osteoarthritis on Quality of Life (QoL)

Abstract: Objective: Functionality and quality of life in patients with osteoarthritis undergoing total arthroplasty of the knee. Materials and Methods: This study was conducted in Ziauddin hospital, Karachi from April 2018 until August 2018, making up 40 individuals who have osteoarthrosis of the knee with an indication for total arthroplasty and not being carriers of any other disease affecting the limbs lower. Two scales of evaluation were applied at two different times: pre and postoperative. Health status questionnaire (SF-36) and Knee injury and osteoarthritis outcome score (KOOS) was applied and answered in the preoperative period (on the day of surgery) and the sixth postoperative week. Results: Regarding the dimensions of activities of daily living and activities, sporting and leisure activities were not statistically significant. Our results go against the conclusions reported by Culliton [1], in a study of 13 patients submitted to TKA. The participants were evaluated before the arthroplasty and four weeks later and the results showed that there was a tendency for pain to decrease in that period. Conclusion: It can be concluded that there was a tendency to decrease pain in this period accompanied by an improvement in the quality of life. Taking into account the results obtained, and stressing the concept that quality of life is related to the state of health of the person and that pain and functional limitation caused by OA negatively influence the well-being and the performance of the activities of the person's daily life, it can be concluded that the TCA contributes to the improvement of the performance of the person. Keywords: Osteoarthritis, Joint, Arthroplasty, Articular cartilage, Osteoarthrosis, Knee injury, QoL.

Effect of adding acupuncture to postoperative rehabilitation treatment for muscle injury pain in patients with anterior cruciate ligament reconstruction: Controlled clinical trial

IntroductionMuscle injuries are prevalent in sports practice among high performance athletes and amateurs. Considering the wide clinical variety of this morbidity (extension and different presentations), there is an interest in studying the effect of acupuncture on the treatment of pain related to muscle injury in an identical model. Microsystem acupuncture is a practical, economical, fast-acting therapeutic resource with few side effects. MethodThis study is a clinical trial in which 22 patients undergoing anterior cruciate ligament reconstruction (ACLR) surgery were divided into two groups. In group 1, the participants received established rehabilitation treatment. Participants in group 2 received acupuncture treatment using nasal microsystem and cranial suture microsystem techniques, in addition to the rehabilitation program, to relieve muscle pain in the graft harvesting region. Participants were assessed for pain outcome by the Numerical Pain Scale (NPS) from the first to the sixth postoperative week. ResultsBoth groups showed a statistically significant reduction in pain as treatment progressed; however, a better outcome was evident in the acupuncture-treated group compared with the control group from the second to the fourth week (p<0.001). There was also a significant reduction in pain score before and immediately after the acupuncture session on the fifth postoperative day (p<0.001). ConclusionThe results of the present study suggest that the addition of acupuncture treatment with nasal microsystem and cranial suture microsystem techniques to the established rehabilitation treatment has brought benefits in reducing thigh muscle pain in the early postoperative period.

The Use of A Solitary Multi-Planer Herbert Cannulated Bone Screw Osteosynthesis for The Treatment of Mandibular Angle Fracture.

This study aimed to evaluate the clinical and radiographic performance of a single Herbert bone screw in the treatment of mandibular angle fractures. A prospective case series clinical trial enrolling a sample of patients with unilateral isolated mandibular angle fractures was implemented in this study. The primary outcome variable was the fracture healing with postoperative stability. The secondary outcome was the incidence of postoperative complications. All of the recorded data were documented, tabulated, computed, and analyzed. Statistical significance was set at 5% level. Twenty patients were selected. Neither major nor minor clinical complication was reported. Only one case showed slight interfragmentary mobility in the first follow-up period, which improved spontaneously in the sixth postoperative week. A statistically significant gain in the mean bone density across the fracture line was calculated. These favorable clinical and radiographic outcomes may conclude that the utilization of a solitary Herbert cannulated bone screw osteosynthesis provides a successful, economic, minimally invasive and predictable treatment modality for the treatment of mandibular angle fractures.