Two-year Follow-up Research Articles

A high offset stem design does not increase stem migration under full weight bearing in cementless total hip arthroplasty: a model-based RSA study

BackgroundHigh-offset stems in cementless primary total hip arthroplasty (THA) have been potentially associated with early aseptic femoral loosening. This study aimed to evaluate the primary and secondary stability of a cementless high-offset femoral component under full weight-bearing conditions using model-based RSA, comparing it with a standard offset stem in patients undergoing THA.MethodsIn this prospective, observational, single-center study, 42 patients with end-stage hip osteoarthritis underwent cementless primary THA using either a standard (SL-PLUS Standard) or a high-offset (SL-PLUS Lateral) cementless stem. Radiostereometric analysis (RSA) was employed to monitor stem migration at six weeks and three, six, twelve, and twenty-four months. Clinical outcomes were assessed using the modified Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).ResultsThere were no significant differences in mean stem subsidence between the groups at any follow-up interval, indicating comparable primary and secondary stability. After minimal initial subsidence (SL-PLUS Standard: up to −0.54 mm; SL-PLUS Lateral: up to −0.73 mm), no further progressive migration was observed. A significant difference in stem anteversion was noted between the groups at six months (P = 0.021) and two years (P = 0.001). The SL-PLUS Lateral group had significantly better WOMAC scores at the two-year follow-up (P = 0.027).ConclusionsThis RSA study demonstrated similar migration patterns for the high-offset and standard-offset cementless stems within the first two years after operation. Both groups exhibited initial subsidence followed by high secondary stability. Based on the results of this study, the SL-PLUS Lateral is a safe alternative for patients with high femoral offset undergoing cementless THA.

Retraction Note: Comment on "Radiographic characterization of OPLL progression in patients receiving laminoplasty with a minimum of two-years follow-up".

Retraction Note: Comment on "Radiographic characterization of OPLL progression in patients receiving laminoplasty with a minimum of two-years follow-up".

Acute Tubular Necrosis Attributed to High-Dose Everolimus with High-Potency Bisphosphonates for Advanced Breast Cancer – A Case Report

Introduction: Everolimus (EVR)-induced kidney injury is rarely reported. Conversely, acute tubular necrosis (ATN) is a recognized complication of high-dose bisphosphonate therapy. Case presentation: SM, a 69-year-old female patient with advanced breast cancer, who developed severe kidney injury necessitating renal replacement therapy (RRT) shortly after initiating EVR treatment, while concurrently receiving chronic high-potency bisphosphonate therapy. Kidney biopsy confirmed ATN. Upon discontinuation of both EVR and bisphosphonates, her renal function gradually improved over several months, leading to the cessation of RRT. At a two-year follow-up, her kidney function has returned to baseline. Conclusion: In this case report, we outline the patient's clinical course and provide a pathophysiological rationale for the synergistic effect of EVR and bisphosphonates in promoting ATN. With the increasing use of EVR in various oncologic indications, we emphasize the reversible nature of this kidney injury and stress the importance of timely recognition and intervention.

3D fracture assessment could be predictive of native hip survival after nonoperative treatment of acetabular fractures.

The aim of the study was to apply 3D measurements for fracture displacement in minimally to moderately displaced acetabular fractures treated nonoperatively, and to evaluate whether this measurement can be used to estimate the likelihood of conversion to total hip arthroplasty (THA) at follow-up. A multicentre, cross-sectional study was performed on 144 patients who were treated nonoperatively for an acetabular fracture in four level 1 trauma centres between January 2000 and December 2020. For each patient, fracture displacement was measured on CT-based 3D models. The 3D gap area represents fracture displacement (mm2) between all fracture fragments. A receiver operating characteristic curve was generated to determine a 3D gap area threshold representing the optimal sensitivity and specificity to predict conversion to THA. Native hip survival was reported using Kaplan-Meier curves. Predictors of conversion to THA were determined using Cox regression analysis. Of 144 patients, 18 (12%) received a THA. The median 3D gap area of the complete study cohort was 692 mm2 (IQR 216 to 1,400). Native hip survival in patients with a gap area threshold ≤ 1,171 or > 1,171 mm2 differed at one-year (98% vs 85%), two-year (96% vs 77%), and five-year follow-up (92% vs 73%). 3D gap area > 1,171 mm2 (hazard ratio (HR) 4.3; 95% CI 1.7 to 11.0) and the presence of osteoarthritis grade 2 or higher (HR 3.1; 95% CI 1.2 to 7.8) independently predicted the likelihood of conversion to THA during follow-up. For nonoperatively treated acetabular fractures, introducing 3D gap area assessment to measure fracture displacement offers a promising approach for assessing the risk of conversion to THA. With the introduction of (semi-)automatic segmentation and measurement techniques, or their implementation into commercially available software, this 3D gap area measurement can serve as an addition to the Letournel classification and an alternative to traditional 2D gap and step-off measurements, improving accuracy, reproducibility, and applicability in clinical decision-making.

Comparison of clinical outcomes among patients treated with high tibial osteotomy and meniscal repair of degenerative medial meniscal tear with mild varus deformity.

The clinical benefits of high tibial osteotomy (HTO) in patients with mild varus deformity with degenerative medial meniscal tear (DMMT) remain unclear. This study aimed to compare clinical outcomes among middle-aged patients with mild varus deformity who underwent arthroscopic meniscal repair and HTO for DMMT. In this retrospective study, patients who underwent isolated arthroscopic meniscal repair via the inside-out technique and those who underwent medial opening-wedge HTO were assigned to group M and H, respectively. The inclusion criteria were: an age of 40-65 years; percentage of mechanical axis of 30-50% measured using full-length weight-bearing anteroposterior radiographs; Kellgren-Lawrence grade ≤ 2; minimum postoperative two-year follow-up; and HTO correction angle < 10°. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and minimal clinically important difference achievement rate for the KOOS subscales preoperatively and at the final follow-up. Group M and H included 21 and 41 patients, respectively. The median ages were 53 and 58 years in groups M and H, respectively. In group H, 24 cases underwent meniscal repair. No significant differences in all KOOS subscales were found preoperatively. However, the median KOOS symptoms subscale in group H (89.3) was significantly better than that in group M (80.4) at the final follow-up (p = 0.04). The main finding of the study indicated that KOOS symptoms after HTO were superior to those after isolated arthroscopic meniscal repair for DMMT. HTO might be a potentially useful treatment for DMMT in middle-aged patients with mild varus deformity, even with a small correction angle. Retrospective comparative study, Level III.

Efficacy of a group-based 8-week multicomponent cognitive training on cognition, mood and activities of daily living among healthy older adults: A two-year follow-up of a randomized controlled trial.

Cognitive training (CT) has been one of the important non-pharmaceutical interventions that could delay cognitive decline. Currently, no definite CT methods are available. Furthermore, little attention has been paid to the effect of CT on mood and instrumental activities of daily living (IADL). To assess the effectiveness of a multicomponent CT using a training program of executive functions, attention, memory and visuospatial functions (TEAM-V Program) on cognition, mood and instrumental ADL. A randomized, single-blinded, treatment-as-usual controlled trial. Geriatric clinic in Bangkok, Thailand. 80 nondemented community-dwelling older adults (mean age 65.7 ± 4.3 years). The CT (TEAM-V) Program or the treatment-as-usual controlled group. The TEAM-V intervention was conducted over 5 sessions, with a 2-week interval between each session. A total of 80 participants were randomized (n = 40 the TEAM-V Program; n = 40 the control group). The Thai version of Montreal Cognitive Assessment (MoCA), The Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Thai version of Hospital Anxiety and Depression Scale (HADS) and The Chula ADL were used to assess at baseline, 6 months, 1 year and 2 years. Compared with the control arm (n = 36), the TEAM-V Program (n = 39) was associated with significantly improved general cognition (MoCA, P = 0.02) at 2 years. Compared with baseline, participants receiving the TEAM-V Program were associated with significantly improved immediate recall (word recall task, P < 0.001), retrieval and retention of memory processes (word recognition task, P = 0.01) and attention (number cancellation part A, P = 0.01) at 2 years. No training effects on anxiety (P = 0.94), depression (P = 0.093) and IADL (P = 0.48) were detected. The TEAM-V Program was effective in improving global cognitive function. Even though, the program did not significantly improve anxiety, depression and IADL compared with the control group, memory and attention improved in the intervention group compared with baseline. Further studies incorporating a larger sample size, longitudinal follow-up and higher-intensity CT should be conducted.

Revision Surgery Rates Following Transforaminal Lumbar Interbody Fusion in Patients with and without Osteoporosis.

Osteoporosis is becoming increasingly prevalent in the spine surgery population and has been shown to be associated with surgical failure in spinal deformity operations. Little is known about the impact of osteoporosis on radiographic and surgical complications following degenerative fusion techniques. To compare complications and radiographic alignment in osteoporotic versus non-osteoporotic patients undergoing transforaminal lumbar interbody fusion (TLIF). Retrospective cohort study. A total of 78 patients, 39 with osteoporosis and 39 without osteoporosis, were included in this study. The following data were observed for all cases: patient demographics, radiographic alignment, and complications. Adult patients with two-year follow-up who underwent transforaminal lumbar interbody fusion (TLIF) at a single academic institution were identified. Eligible patients were propensity matched by the presence of osteoporosis while accounting for age, sex, and BMI. Patient demographics, procedural characteristics, preoperative to two-year postoperative change in spinopelvic alignment, and complications were compared. Multivariate regression analyses, accounting for age, gender, and Charlson Comorbidity Index (CCI), were performed to evaluate outcomes following TLIF. In total, 78 patients with complete data were included with a mean age of 63.28, 70.51% were female, mean CCI was 1.02 and mean clinical follow up was 33.3 months. At two years postoperatively, osteoporosis patients had a significantly greater increase in PI-LL from pre-operation (6.55° vs -0.02°, p=0.010). In addition, while there was no statistically significant difference in medical and surgical complication (all p>0.05), osteoporosis patients were 2.8 times more likely to develop adjacent segment diseases (p=0.05). Additionally, over 30% of patients with osteoporosis underwent revision and osteoporotic patients were 9.2 times more likely to undergo revision (p=0.008) than patients without osteoporosis, most commonly for adjacent segment disease. In this single-center multi-surgeon study, osteoporotic patients experienced significant worsening of PI-LL mismatch postoperatively and had a higher incidence of adjacent segment disease and revision. Although TLIF remains an important procedure in osteoporotic patients, increased care should be taken to optimize bone quality in the perioperative period to avoid potential mechanical and surgical complications.

Retraction Note: Letter to editor: Comment on, "Radiographic characterization of OPLL progression in patients receiving laminoplasty with a minimum of two-years follow-up".

Retraction Note: Letter to editor: Comment on, "Radiographic characterization of OPLL progression in patients receiving laminoplasty with a minimum of two-years follow-up".

The associations between fresh vegetable and fruit consumption and plasma and PET biomarkers in preclinical Alzheimer's disease: A cross-sectional and longitudinal study of Chinese population.

The identification of the modifiable lifestyle factors including dietary habits in older adults of preclinical Alzheimer's disease (AD) and early effective interventions are of great importance. We studied whether the consumption of fresh vegetables and fruits was different between cognitively unimpaired (CU) and cognitively impaired (CI) population and mainly investigated the associations between vegetable and fruit consumption and PET and plasma AD biomarkers in older CU adults with higher β-amyloid (Aβ) burden. Older adults with the age of 50-85 years were enrolled for a cross-sectional and longitudinal study. The groups depended on whether the participants were CU or CI. Partial participants whose habits remained unchanged were followed up. The consumption data of vegetables and fruits were collected using a validated self-reported questionnaire. We mainly investigated the associations between vegetable and fruit consumption and various biomarkers in CU participants with positive 18F-florbetapir PET scan (Aβ-PET), part of whom also underwent plasma AD biomarkers tests and 18F-MK6240 PET scan (tau-PET). Correlation and multiple linear regression analyses were used to investigate the associations between vegetable and fruit consumption and AD biomarkers. A total of 1433 participants were enrolled, of which CU accounted for 49.4 %. Most of the intake habits of vegetables and fruits was different between CU and CI participants. 177 CU participants with Aβ-PET positive were selected for the following study. Multiple linear regression analysis showed higher consumption of fresh vegetables (>200 g/d), dark vegetables (>100 g/d, ≥2d/week), fruits (>100 g/d), berries (>100 g/d) and grapes (>100 g/d) more or less had associations with the plasma biomarkers including Aβ40, t-Tau, p-Tau-181 and neurofilament light chain as well as amyloid and Tau PET biomarkers. Most of the habits were associated with the change of cognitive function after an approximately two-year follow-up. Especially, higher intakes of fruits and grapes correlated with both lower Aβ and Tau burden and inversely with cognitive decline after follow-up. Our data indicates that higher consumption of vegetables, dark vegetables, fruits, berries and grapes is associated with amyloid and Tau PET and plasma biomarkers in preclinical AD participants and the changes of cognitive function after follow-up. Higher intakes of fruits (>100 g/d) and grapes (>100 g/d) may be more helpful for reducing the risk of AD development.

Management of Coexisting Patent Foramen Ovale and Pulmonary Arteriovenous Malformation: A Case Report of Sequential Closure

Abstract Background Concurrent patent foramen ovale (PFO) and pulmonary arteriovenous malformation (PAVM) are rare but can cause paradoxical embolism and platypnea-orthodeoxia syndrome (POS). Case Summary A 72-year-old female with embolic stroke history developed positional dyspnea. Evaluation revealed right-to-left shunting through PFO and PAVM in the right middle lobe. Orthodeoxia was confirmed by 6% SpO2 decrease upon position change. A staged approach was adopted: PFO closure with Amplatzer™ Occluder, followed by PAVM embolization one month later. Symptoms improved significantly post-procedure. No residual shunting or symptoms have been observed during the two-year follow-up. Discussion This case emphasizes thorough evaluation in patients with cryptogenic stroke and POS, especially when symptoms persist. It demonstrates the effectiveness of staged treatment for concurrent PFO and PAVM, highlighting the importance of individualized strategies and long-term follow-up.

A Canadian Post-Market Study of the Zenith Alpha Abdominal Endovascular Graft.

To evaluate the performance of the low-profile Zenith Alpha Abdominal Endovascular Graft in a Canadian post-market setting. A prospective, multicenter, non-randomized, post-market study was conducted at 5 sites in Canada between May 2017 and June 2018. Patients were treated for abdominal aortic or aorto-iliac aneurysms using the Zenith Alpha Abdominal Endovascular Graft and followed for 2 years after the initial procedure in accordance with each institution's standard of care. A total of 100 patients (mean age 75.2 ± 7.4 years, 88% male; 16% with aortoiliac aneurysms) were treated. Technical success was achieved in 99% (98/99) of patients. One patient was excluded from the technical success endpoint due to missing data. The single technical failure was due to partial coverage of the left renal artery by the main body graft. Mean follow-up duration was 635.9 ± 213.6 days. Device success through two-year follow-up was achieved in 86.9% (86/99) of patients. Overall, 9 deaths occurred; none were related to the study device nor to the procedure. No patient required conversion to open surgery. Through follow-up, 4 patients experienced a Type I endoleak. There were no instances of Type III or IV endoleaks. One case of aneurysm rupture (related to Type Ib endoleak and retrograde migration of an iliac leg graft) was successfully treated with angioplasty, coil embolization, and iliac graft extension. Eight patients experienced aneurysm growth >5mm throughout follow-up. Iliac leg graft occlusions occurred in 5 patients. In total, 14 patients required 15 secondary interventions. Iliac leg-graft-related secondary interventions were performed in 7 patients, for device occlusion (n=3), kink/compression (n=2), stenosis(n=2), or non-occlusive thrombus (n=3). Other reasons for secondary interventions included Type II endoleak (n=8), Type Ib endoleak (n=2), iliac artery dissection (n=1), abdominal aortic aneurysm rupture (n=1), and partial coverage of the left renal artery (n=1). The Zenith Alpha Abdominal Endovascular Graft demonstrates high rates of technical success, no open conversions, and no aneurysm -related mortality after abdominal aortic or aorto-iliac aneurysm repair. Type I endoleak rates were low. These outcomes support the safety and performance of the Zenith Alpha Abdominal Endovascular Graft.

Opportunities, challenges, and difficulties in NMR-based metabolomics applied to neovascular age-related macular degeneration (nAMD) patient follow-up

IntroductionThis study applies NMR-based metabolomics to investigate neovascular age-related macular degeneration (nAMD), addressing challenges in patient management, disease progression evaluation, and treatment response assessment. A two-year follow-up of 29 nAMD patients undergoing treatment provided 231 time points for analysis.MethodsOver the two-year period, 11 males and 18 females (aged 61–92 years) were monitored, yielding 231 time points. At each time point, blood samples for NMR metabolomics analysis, clinical measurements (e.g., lactate, glucose levels, HDL/LDL cholesterol, and blood pH), and optical coherence tomography (OCT) images were collected to evaluate the progression of choroidal neovascularization. 1H-NMR metabolomic analysis led to the quantification of over 60 metabolites and of the major lipoprotein fractions. Both multivariate and univariate statistical approaches tailored for longitudinal data were employed to identify biomarkers correlating metabolomic changes with ocular alterations during disease progression.Results and DiscussionDespite a rigorous analytical workflow enabling precise quantification of over 60 metabolites and the application of advanced statistical tools for longitudinal data, achieving consistent results across the cohort proved challenging. The dataset’s heterogeneity, reflecting real-world clinical practice, complicated the derivation of global conclusions. Personalized analyses on a patient-by-patient basis successfully identified individual correlation models, but a universal model remained elusive. This study highlights the inherent challenges of translating findings from controlled settings into clinical practice, where factors such as visit frequency, treatment variability, and disease heterogeneity limit data uniformity. We emphasize the importance of experimental design in longitudinal studies, particularly when dealing with incomplete and variable datasets. We are therefore confident that, considering both the challenges and difficulties identified in this work and the preliminary results presented here, it is possible to develop predictive and individualized models for monitoring patients with nAMD. Such models could greatly assist clinicians in providing better care for these patients.

Clinical Outcomes and Safety Profiles of Generic Versus Brand-Name Clopidogrel in Patients Following Coronary Artery Stent Placement.

Coronary artery disease remains a significant global health issue and is a leading cause of mortality. Dual antiplatelet therapy, including clopidogrel, is essential for preventing stent thrombosis after coronary artery stenting. This study assessed the comparative efficacy and safety of generic versus brand-name clopidogrel in a large Taiwanese cohort. A retrospective cohort study was conducted using the National Health Insurance database, identifying patients who underwent coronary stenting and received either generic or brand-name clopidogrel between January 1, 2008, and December 31, 2021. Propensity score matching was employed to balance baseline characteristics. The primary efficacy outcome was a composite of myocardial infarction, ischemic stroke, or cardiovascular death over a two-year follow-up. The primary safety outcome was major bleeding requiring hospitalization. A total of 211,509 patients were included, of which 2686 received generic clopidogrel and 208,823 received brand-name clopidogrel. After matching, 2686 patients from each group were analyzed. The hazard ratio for the primary efficacy outcome was 0.92 (95% confidence interval: 0.78-1.10), indicating no significant difference between the two groups. The subdistribution hazard ratio for the primary safety outcome was 1.06 (95% confidence interval: 0.84-1.33), suggesting no significant difference in bleeding risk. Subgroup analyses showed consistent results across various patient demographics and clinical conditions. In conclusion, among patients undergoing coronary stenting, the risks of ischemic and bleeding events were comparable between those receiving generic and brand-name clopidogrel.

Family Functioning, Life Satisfaction, and Depressive Symptoms in Chinese Adults With Diabetes and Hypertension: A Cross-Lagged Model.

This study aims to evaluate the bidirectional relationship between family functioning and depressive symptoms, considering life satisfaction as a potential mediator and gender, age and income as a moderator of these associations. A longitudinal study was conducted with 708 Chinese adults with diabetes and hypertension (51.6% women; mean age: 64.1±7.7years) recruited from 12 community health services. Data were collected at baseline (T1), one-year follow-up (T2), and two-year follow-up (T3) using self-reported assessments of family functioning, depressive symptoms, and life satisfaction. Depressive symptoms negatively predicted family functioning from T1 to T2, and family functioning negatively predicted depressive symptoms from T2 to T3. Furthermore, life satisfaction mediated the relationship between family functioning and depressive symptoms from T1 to T3, and vice versa. Differences in gender, age, and income showed distinct patterns. Life satisfaction at T2 mediated the effect of family functioning at T1 on depressive symptoms at T3 for men, women, middle-aged and low-income adults, whereas life satisfaction mediated the effect of depressive symptoms at T1 on family functioning at T3 only among women and low-income adults. This study explores the relationships among family functioning, life satisfaction, and depressive symptoms, noting potential differences based on gender, age and income. Family-level interventions targeting life satisfaction could a helpful approach to addressing depressive symptoms among Chinese adults aged 45 and older with type 2 diabetes and/or hypertension.

Retraction Note: Comment on, "Radiographic characterization of OPLL progression in patients receiving laminoplasty with a minimum of two-years follow-up".

Retraction Note: Comment on, "Radiographic characterization of OPLL progression in patients receiving laminoplasty with a minimum of two-years follow-up".

P-17 THE HIDDEN CULPRIT: CELIAC DISEASE IN A POSTPARTUM OSTEOPOROSIS PATIENT

Abstract Introduction Pregnancy and lactation-associated osteoporosis is a rare type of osteoporosis that is often accompanied by vertebral fractures. It is considered to be a result of pregnancy-related factors, as well as due to underlying secondary causes. Here we present a case of severe hypocalcemia following parenteral zoledronic acid administration for postpartum osteoporosis, in which further evaluation for secondary causes had not been made and underlying Celiac disease was missed. Clinical Case A 34-year-old female patient had applied to an out-patient clinic with widespread bone pain at third month postpartum. She was diagnosed as postpartum osteoporosis based on examination with the dual X-ray absorptiometry (DXA) scan. Lumbar spine L1-L4 bone mineral density (BMD) and Z-score was found 0.614 g/cm²; and -3.9 respectively. No data was present regarding a fracture. She was referred to our clinic with severe muscle cramps and numbness following administration of Zolendronic acid 5 mg intravenously. The patient denied any chronic diseases, but she noted that she had undergone an intestinal operation due to ileus when she was 22 years old. She had a history of four pregnancies and had breastfed each of her children for at least a year. Family history was insignificant. On physical examination, symptoms of proximal myopathy, Chvostek and Trousseau signs were evident. Laboratory investigation revealed severe hypocalcemia; results of laboratory were as follows: Corrected-Ca: 5.5 mg/dL, P: 1.8 mg/dL, 25-Hydroxyvitamin D: 6.4 g/L, Parathormone (PTH): 1044 pg/mL, and Alkaline phosphatase (ALP): 269 U/L. In addition to parenteral and oral calcium, calcitriol and cholecalciferol treatments were started subsequently. Upon further evaluation for the secondary causes of osteoporosis, Celiac antibodies tested positive, additionally the appearance of the upper gastrointestinal system endoscopy and the biopsy of the second part of the duodenum were found to be compatible with Celiac disease. Thus, the patient's follow-up continued with calcium and vitamin D replacements, as well as dietary adjustments for celiac disease. The patient has been followed up in our clinic for approximately two years, a significant increase in bone density and improvement in biochemical values were detected with the current diet and replacements. DXA scans: 2022: Femoral neck BMD 0.694 g/cm², Z-score -1.5; Lumbar spine L1-L4 BMD: 0.614 g/cm², Z-score: -3.9 2024: Femoral neck BMD 1.080 g/cm², Z-score +1.2 Lumbar spine L1-L4 BMD 1.246 g/cm², Z-score: +0.8 Conclusion In patients presenting with postpartum osteoporosis, secondary causes should be investigated and treatment should be determined according to diagnosis. Bisphosphonate treatment in postpartum osteoporosis can be applied only to a group of individually selected patients and adequate calcium and vitamin D supplementation should be given prior to treatment.Table 1:Laboratory FindingsLaboratory findings during the two-year follow-up of the patient

An Open Randomized Controlled Trial Comparing Group and Individual Parent-Child Interaction Therapy for Preschoolers with Attention-Deficit/hyperactivity Disorder

ABSTRACT Background Parent-Child Interaction Therapy (PCIT), an evidence-based treatment for children with disruptive behavior, has limited research investigating its efficacy for children with attention-deficit/hyperactivity disorder (ADHD). Objective This study compared group and individual PCIT for young children with ADHD with and without co-occurring disruptive behavior disorders (DBDs). Method This open randomized controlled trial examined group and individual PCIT for 4–6-year-old children (n = 128) with ADHD with and without co-occurring DBDs at pre-treatment, post-treatment, one- and two-year follow-up. Results Parent-reported disruptive behavior and ADHD symptomatology decreased following treatment, regardless of diagnosis or format, with improvements maintained at follow-up. For children with ADHD only, individual PCIT resulted in higher rates of reliable change in disruptive behavior compared to group PCIT. Individual and group PCIT appear to be effective treatments for children with ADHD with or without DBDs. Most children experienced clinically significant ADHD symptom improvement following PCIT, though rates of reliable improvement in disruptive behavior appear greater in children with ADHD only. Conclusions These findings highlight the potential utility of PCIT in both individual and group formats for treating childhood ADHD symptoms and co-occurring disruptive behavior. While this study suggests PCIT may be beneficial as a treatment option for children with ADHD, potentially reducing reliance on medication-based treatments, further research is needed to confirm these results and their generalizability to non-parental contexts.

Functional Alignment Achieved a More Balanced Knee After Robotic Arm-Assisted Total Knee Arthroplasty than Modified Kinematic Alignment

Background: The aim of this study was to evaluate the balance in extension and flexion achievable after total knee arthroplasty (TKA) using a modified kinematic alignment (KA) plan and the subsequent balance achievable after adjusting the component based on the functional alignment (FA) principle. Methods: This retrospective cohort study included 100 consecutive patients who underwent primary TKA for knee osteoarthritis through an image-based robotic system in a single center between October 2021 and February 2022. Whether modified KA or FA could achieve a balanced knee was evaluated by assessing the ligament balance in the medial and lateral compartments using a robotic system at extension and 90° flexion. Balance was defined as a difference of ≤2 mm between the compartments. Component positioning was adjusted within limits based on the functional positioning principles to achieve balance. Implant positioning and balance in extension and 90° flexion were compared between the modified KA plan (n = 100) and after FA adjustments (n = 100). Results: FA achieved significantly better balance in extension (FA, 99.0% vs. modified KA, 86.0%; p = 0.001) and flexion (98.0% vs. 43.0%; p &lt; 0.001) than the modified KA plan. The mean difference in gap balance in extension (FA, 0.1 mm vs. modified KA, 0.6 mm; p = 0.001) and flexion (0.1 mm vs. 2.3 mm; p &lt; 0.001) was also significant between the two techniques. The femoral component was positioned more externally rotated relative to the transepicondylar axis (FA, 2.5° vs. modified KA, 0.0°; p &lt; 0.001) to obtain balanced targets. There were significant improvements in the patient-reported outcome measures between preoperative and postoperative assessments two years after TKA (all p &lt; 0.05). Conclusions: FA consistently achieved superior balance in both extension and flexion following TKA compared with modified KA without altering the soft tissue envelope, leading to significant improvements in clinical outcomes at the two-year follow-up.

Health-related quality of life, lifestyle habits and chronic pain in individuals with knee pain – a 2-year follow-up study

Introduction Knee pain increases the risk of developing chronic widespread pain (CWP) and knee osteoarthritis (KOA). The prevalence of CWP and KOA has increased, and there is a need for early prevention. Therefore, the aim was to examine the associations of health-related quality of life (HRQoL) and lifestyle habits with chronic pain at a two-year follow-up in individuals with knee pain. Methods A two-year longitudinal cohort study including 251 individuals aged 30–60 years reporting knee pain at baseline. HRQoL was measured via the Short-Form General Health Survey (SF-36), and lifestyle habits included questions on overweight, physical activity, diet, alcohol and tobacco use. Pain was assessed with a pain mannequin. Differences in health status and lifestyle habits over time in groups with unchanged no chronic pain (NCP), transitioned to less and more pain, and unchanged CWP were analysed using Wilcoxon’s, McNemar’s and Friedman’s tests. Multinominal regression analysis was performed to study associations with reporting chronic pain at follow-up. Results Reporting better HRQoL across various SF-36 concepts and normal weight at baseline was associated with reporting NCP after two years. A few changes were made regarding HRQoL and lifestyle habits over the course of two years, but an increase in general health was associated with transitioning to less pain. Conclusions During primary care visits for knee pain with a combination of overweight or lower HRQoL, individuals should receive comprehensive attention to prevent the development of CWP. Future studies should investigate the associations further.

A comparative study between central quadrantectomy and nipple resection with areola preservation Versus Grisotti flap mammoplasty in central breast lesions extending to nipple: a randomized clinical trial

ObjectivesTo evaluate central quadrantectomy and nipple resection with areola preservation (CQ-NR-AP) as a new reconstructive oncoplastic technique Versus Grisotti flap mammoplasty (GFM) in central malignant tumors of the breast extending to the nipple, in terms of time procedures, breast symmetry, patient satisfaction, postoperative complications, and local recurrence.Patients and methodsThe current study is a single-blind, single-center, randomized, controlled trial that was performed between May 2018 and May 2023 in the breast surgery unit of University Hospitals. This trial involved 40 individuals who had central breast lesions that extended to the nipple and were monitored for two years following surgery.ResultsAs regards the mean intra-operative time in minutes, in the group (I) was 80.1 with a standard deviation of ± 13.9, and ingroup (II) was 138.9 with a standard deviation of ± 14.02 (p = 0.001). The seroma was detected in zero cases in group (I) and 2(10%) cases in group II (p = 0.487) and those two cases were managed by aspiration only. Regarding, the wound infection was found in one case (5%) in group (I) and 3(15%) cases in group II (p = 0.605). Regarding patient satisfaction and breast, symmetry was much better in the group (I).ConclusionThe safety and ease of central quadrantectomy and nipple resection with areola preservation were demonstrated in a two-year follow-up, with a lower incidence of complications compared to the Grisotti flap mammoplasty technique. Furthermore, this approach was associated with higher patient satisfaction, which is a significant achievement in the management of centrally located breast tumors.Trial registrationPACTR202405688323721. 28/05/2024.