Unhealed Group Research Articles

Key Decision-Making in Post-Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study onFractureHealing'sImpact on Femoral Component Selection.

Following failed internal fixation of intertrochanteric fractures (FIF-ITF), the decision to use a long-stem or standard-stem femoral implant in hip arthroplasty is still debated. This study aimed to explore how the healing status of fractures after FIF-ITF failure affects the choice of femoral stem and clinical outcomes. Our retrospective cohort study reviewed 105 cases of patients with FIF-ITF who underwent hip arthroplasty at three tertiary Grade A hospitals between December 2012 and December 2022. We compared the clinical outcomes between patients with healed and unhealed fractures, focusing on the selection of femoral stems in relation to proximal medial support and the healing status of the greater trochanter. The primary outcomes measured were functional results, operative time, blood loss, and incidence of complications. A subgroup analysis was conducted to further evaluate the influence of the proximal medial buttress and greater trochanteric healing on femoral stem selection. Statistical analysis included binary and ordinal logistic regression to identify factors influencing the choice of femoral stems. Additionally, a decision tree model was developed to visually represent and explore the relationship between fracture healing status and the selection of femoral components. The study included 38 patients with healed fractures and 67 patients with unhealed fractures. Patients in the healed group predominantly chose standard stems and experienced better functional outcomes (p < 0.001, p = 0.002). In contrast, the unhealed group preferred long stems, resulting in longer surgical durations and increased blood loss (p = 0.008, p < 0.001). Binary logistic regression analysis revealed that nonunion of the proximal femoral medial buttress was an independent risk factor for long stems (p < 0.0001, OR = 10.402). The selection of femoral prostheses following FIF-ITF is influenced by the fracture healing status, particularly the presence of proximal femoral medial buttress. The decision tree model suggested that long-stem prostheses are more appropriate when there is inadequate fracture healing and the proximal femoral medial buttress is absent.

Comparison of Clinical Outcomes Between Arthroscopic Rotator Cuff Repair and Reverse Total Shoulder Arthroplasty in Patients With Massive Rotator Cuff Tears and High-Grade Fatty Atrophy Without Glenohumeral Osteoarthritis.

Despite the effectiveness of reverse total shoulder arthroplasty (RSA) and arthroscopic rotator cuff repair (ARCR) for treating massive rotator cuff tears (MRCTs), controversies remain in patients without glenohumeral osteoarthritis (GHOA). To compare clinical outcomes of ARCR or RSA in patients with MRCT with high-grade fatty atrophy without GHOA. Cohort study; Level of evidence, 3. This was a retrospective study on patients with MRCTs without GHOA and with grades 3 or 4 Goutallier muscle changes who underwent ARCR or RSA, with a minimum 2-year follow-up. Range of motion (ROM) and patient-reported outcomes (PROs) were collected-including visual analog scale for pain, American Shoulder and Elbow Surgeons score, Veterans Rand 12-Item Health survey, and Subjective Shoulder Value. Postoperative results were compared based on rotator cuff tendon healing in the ARCR group. A total of 81 patients met the study criteria-56 underwent ARCR and 25 underwent RSA. Patients in the RSA (age, 71.7 ± 7.7 years) group were older than those in the ARCR (age, 66.7 ± 7.4 years) group (P = .01) and more likely to have pseudoparalysis (52% vs 21.4%; P = .016). The mean follow-up for the ARCR and RSA groups was 56.5 ± 19 months and 36.1 ± 7.6 months, respectively (P < .001). The rate of patients with ≥2 tendons with grade 3 or 4 changes was higher in the RSA group compared with the ARCR group: 96% versus 47% (P < .001). PROs significantly improved after surgery in both groups (P < .05). Postoperative forward flexion (FF) and internal rotation were higher after ARCR compared with RSA-144°± 22° versus 113°± 25° and L3 ± L4 versus S1 ± S2, respectively (P <.001 and P = .002, respectively). Also, 31 of the rotator cuff repairs (55%) healed. PROs were similar between the healed and unhealed ARCR groups, with the only difference observed in postoperative FF-150°± 18° in the healed group versus 136°± 26° in the unhealed group (P = .044). Both ARCR and RSA improved functional outcomes in patients with MRCT without GHOA. While healing was moderate after ARCR, the postoperative ROM was greater after ARCR compared with RSA in appropriately selected patients. Moreover, healed rotator cuffs demonstrated improved postoperative FF compared with unhealed repairs.

Long-term outcomes of fistula-tract laser closure for complex perianal fistulizing Crohn's disease.

Fistula-tract laser closure (FiLaC™) has shown promising outcomes in perianal fistulizing Crohn's disease (pfCD). However, most studies assessed a mixed cohort encompassing pfCD and cryptoglandular fistulas during a short follow-up period. This study aimed to evaluate the long-term treatment outcomes of FiLaC™ in patients with complex pfCD. Data from patients with complex pfCD who underwent FiLaC™ during deep remission of Crohn's disease between January 2019 and December 2020 were retrospectively analyzed. Patient demographics, surgery history, and medication strategy were registered before surgery. Follow-ups were scheduled at 1, 2, and 3months after FiLaC™, and at 2-month intervals thereafter. The primary endpoint was clinic healing, while clinic remission/unhealed/recurrence were classified as unhealed. Additionally, adverse events and Wexner fecal incontinence score were documented. Forty-nine patients (40 men and 9 women) with a median age of 26.0 (19.0-35.5) years were included with a median follow-up of 50.0 (39.5-54.0) months. Of these, 31 (63.3%) patients achieved fistula healing, 3 (6.1%) experienced improvement, 3 (6.1%) remained unhealed, and 12 (24.5%) experienced recurrence. Montreal A category was lower in the healed group (P < 0.001). No major complications, such as bleeding or fecal or urinary incontinence, were observed, and pain was transient. The Wexner incontinence score decreased significantly at the last available follow-up, indicating an intact postoperative continence function (P = 0.014). PCDAI scores were significantly higher in the unhealed group (P = 0.041). FiLaC™ is an efficient and safe sphincter-saving procedure for patients with complex pfCD.

Clinical and MRI Outcomes of Repaired Peripheral Longitudinal Tears of the Posterior Horn of the Medial Meniscus With ACL Reconstruction: Results According to Tear Size.

Arthroscopic repair of longitudinal tears in the medial meniscal posterior horn (MMPH) has been reported to result in high rates of meniscal healing when performed alongside anterior cruciate ligament reconstruction (ACLR). However, studies that have focused on longitudinal tears and their impact on clinical outcomes after arthroscopic repair are insufficient. To investigate the clinical outcome and healing status after concomitant arthroscopic ACLR and repair of MMPH peripheral longitudinal tears, with respect to the tear length. Cohort study; Level of evidence, 3. A total of 263 patients who underwent concurrent arthroscopic suture repair of longitudinal tears of the MMPH and ACLR were enrolled. All patients had 2-year postoperative magnetic resonance imaging (MRI) evaluations, and 61% of patients underwent a second-look arthroscopy. The exclusion criteria were partial meniscectomies and multiligament injuries. Patients were assessed pre- and postoperatively for clinical scores, amount of anterior translation, grade of pivot shift, and presence of meniscal tear extension. According to the length of longitudinal tears, patients were classified into 2 groups: (1) patients with tears that were located in the posterior compartment and (2) patients with tears that extended to the midbody of the meniscus. Binary stepwise logistic regression analysis was used to evaluate the risk factors for unhealed menisci as identified by MRI. A total of 83 patients were included in this study-52 patients (group 1) had MMPH tears without tear extension and 31 patients (group 2) had MMPH tears with tear extension. There were no differences in outcomes between the groups, including the healing rate after meniscal repair (P > .05). Based on postoperative MRI scans, 67 patients (80.7%) were categorized as completely healed and 16 patients (19.3%) as unhealed. There were no significant differences between the completely healed and unhealed groups in outcomes or the rate of preoperative midbody tear extension. Higher body mass index and lower preoperative Lysholm scores were identified as risk factors for unhealed menisci. Overall, the rate of complete healing of MMPH tears repaired concomitantly with ACLR was 80.7% (67/83), and midbody tear extension did not affect the healing rate of the repaired meniscus. Results indicate that suture repair for unstable MMPH tears should be considered regardless of tear size.

520-P: Bedside Amputation Surgery for Isolated Toe(s) Necrosis in a Diabetes Department—Prognostic after One-Year Follow-up

For isolated toe(s) necrosis complicating diabetic foot ulcers (DFU), level of amputation is a frequent topic of disagreement between diabetologists and surgeons. Bedside Amputation Surgery (BAS) performed by a diabetologist might be an option to get rid of a major surgery (complete transmetatarsal amputation [TMA] or transtibial amputation [TTA]) usually and initially recommended by the surgeon in this case. Indications of this practice need to be specified. This monocentric, retrospective, observational study assessed the outcome at 1 year of patients with diabetes mellitus (DM) after an accessible BAS performed by the diabetologist for isolated and delimited toe(s) necrosis consisting of transphalangeal amputation, metatarsophalangeal disarticulation or TMA of one axis. The primary endpoint is the one-year healing rate without secondary surgery performed by a surgeon in the operating room. Out of 783 patients admitted for DFU (05/2016-10/2021), 66 underwent BAS (8.5%). One-year follow-up was achieved for 55 patients (5 deaths from other causes and 6 lost of follow-up): males 82%, type 2 DM 96%, DM median duration 18 years, median HbA1C 9%. One-year healing rate was 62% (34/55). Among 21/55 patients with no healing at 1 year, 19 received secondary surgery in the operating room (TTA 32% (6/19), complete TMA 37% (7/19) and revision surgery gesture 31% (6/19), median delay: 41 days). Failure was observed in patients with more severe leg arteriopathy (1 vs 2 vascular leg axes, p=0.03) with no significant difference in foot vascularization. Soft tissue infection at the time of BAS was significantly more present in the unhealed group (80% vs 47%, p=0.02) with a higher CRP level (84 vs 23mg/L, p= 0.001). BAS allows optimal care in about 2 out of 3 cases, avoiding the need to perform major surgeries. The number of vascular leg axes (&amp;lt;1) as well as degree of soft tissue infection need to be assessed before suggesting the indication. Disclosure F.Féron: None. J.Riveline: Board Member; Abbott Diabetes, Medtronic, Dexcom, Inc., Novo Nordisk, Eli Lilly and Company, Sanofi. J.Gautier: Advisory Panel; Bayer Inc., Eli Lilly and Company, Sanofi, Other Relationship; Novo Nordisk. J.Kevorkian: None.

Therapeutic outcome and long-term naturalistic follow-up of female adolescent outpatients with AN: clinical, personality and psychopathology evolution, process indicators and outcome predictors

BackgroundAnorexia nervosa (AN) is a serious mental illness of growing prevalence in childhood and adolescence. Despite its severity, there are still no completely satisfactory evidence-based treatments. Follow-up studies represent the most effective attempt to enlighten treatment effectiveness, outcome predictors and process indicators.MethodsSeventy-three female participants affected with AN were assessed at intake (T0) and at 6 (T1) and 12 (T2) months of an outpatient multimodal treatment program. Nineteen participants were assessed 15 years after discharge (T3). Changes in diagnostic criteria were compared with the chi-square test. Clinical, personality and psychopathology evolution were tested with ANOVA for repeated measures, using the t-test or Wilcoxon test as post-hoc. T0 features among dropout, stable and healed participants were compared. Healed and unhealed groups at long-term follow-up were compared using Mann-Whitney U test. Treatment changes were correlated to each other and with intake features using multivariate regression.ResultsThe rate of complete remission was 64.4% at T2, and 73.7% at T3. 22% of participants maintained a full diagnosis at T2, and only 15.8% at T3. BMI significantly increased at each time-point. A significant decrease of persistence and increase in self-directedness were evidenced between T0 and T2. Interoceptive awareness, drive to thinness, impulsivity, parent-rated, and adolescent-rated general psychopathology significantly decreased after treatment. Lower reward dependence and lower cooperativeness characterized the dropout group. The healed group displayed lower adolescent-rated aggressive and externalizing symptoms, and lower parent-rated delinquent behaviors. BMI, personality and psychopathology changes were related with each other and with BMI, personality and psychopathology at intake.ConclusionA 12-months outpatient multimodal treatment encompassing psychiatric, nutritional and psychological approaches is an effective approach for the treatment of mild to moderate AN in adolescence. Treatment was associated not only with increased BMI but also with positive personality development, and changes in both eating and general psychopathology. Lower relational abilities may be an obstacle to healing. Approaches to treatment resistance should be personalized according to these finding.

Is early mobilization necessary in isolated rotator cuff repair? Results of a prospective series of 1,200 cases

Objectives:Non-healing of rotator cuff tears is estimated to be between 5 and 20%. Rehabilitation protocols vary. Some advocate early rehabilitation. The aim of the study was to verify whether rapid recovery of mobility was not associated with a higher rate of non-healing.Methods:We conducted a single-center prospective study. The primary inclusion criterion was first-line arthroscopic repair of an isolated complete cuff tear without retraction (Patte 1) or fatty degeneration (Goutallier - less than 2). It was the same surgeon, the same surgical technique (double row) and the same rehabilitation protocol (self-mobilization, hands together). Patients were seen again by an evaluator other than the surgeon. We analyzed passive elevation and external rotation (ER1) mobility and pain at 6 weeks, 3 months, and 6 months, active mobilities at 3 months and 6 months, and the Constant score at 6 months. Tendon healing was assessed at six months by ultrasound according to Sugaya’s classification (grouping 1/2/3 healed and 4/5 unhealed).Results:1,200 patients were included, 101 were excluded (lost to follow-up or missing data at one of the reviews). The healing rate was 85.7%. We noted a statistically significant difference between the healed and unhealed groups for passive elevation at 6 weeks (128° vs 142° p <0.0001), passive ER1 (23°/32°, p <0.0001). As well as at 3 months for passive elevation (149°/155°, p = 0.0005) for ER1 (43°/48°, p = 0.0008). No difference in pain between the 2 groups (at each review) nor in the final Constant score (72.3 vs 70.2)Conclusion:Patients with poorer passive joint mobility at 6 weeks and 3 months postoperatively had a better healing rate at 6 months. This clear correlation is an indication that we should reflect on the earliness of rehabilitation after rotator cuff repair.

Deep Venous Stenting Improves Healing of Lower Extremity Venous Ulcers

Long standing, recalcitrant venous ulcers fail to heal despite standard compression therapy and wound care. Stenting of central veins has been reported to assist in venous ulcer healing. This study reports outcomes of deep venous stenting for central venous obstruction in patients with recalcitrant venous ulcers at a single comprehensive wound care center. A single center retrospective analysis was conducted of patients with CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) 6 disease that had undergone deep venous stenting in addition to wound care and compression therapy. Intra-operative details, wound healing, and stent patency rates were recorded. Stent patency and intra-operative details were compared between the healed and unhealed groups. Between 2010 and 2019, 15 patients met inclusion criteria (mean age: 63 years old, 12 males). Pre-operative mean wound area was 14.1 cm2 with mean wound duration of 30 months. 93% of patients healed the ulcers at mean healing time of 10.6 months. Wound recurrence rate was 57% with mean recurrence time of 14.8 months. Ten patients presented with an inferior vena cava (IVC) filter, 4 in the healed group and 6 in the unhealed group. The common iliac vein was stented in all patients. Extension into the IVC was required in 4, the common femoral vein in 11, and femoral vein in 2 patients. The average stent length was 190cm. During the follow-up period, primary patency rates in healed patients (mean follow-up time: 19.2 months) was 83% and 59% in the unhealed group (mean follow-up time: 36.6 months); secondary patency rates were 83% and 89%, respectively. In patients with recalcitrant venous ulcers with central venous obstruction, deep venous stenting resulted in a high rate of healing. However, a prolonged 10 month healing time was observed and despite high stent patency, wound recurrence rate was high.

Early and Intensive Glycemic Control for Diabetic Foot Ulcer Healing: A Prospective Observational Nested Cohort Study.

We aimed to assess the effect of glycemic control on diabetic foot ulcer (DFU) healing. A prospective nested cohort study was employed of individuals with poorly controlled diabetes (glycated hemoglobin [HbA1c] >9%) and neuropathic DFU of >2-week duration. All individuals received standard diabetes and ulcer interventions for 12 weeks. Baseline demographic characteristics, ulcer area (automated assessment by wound zoom camera), and biochemical parameters were analyzed. The cohort was stratified into ulcer healed and unhealed groups. Ulcer area and glycemic parameters at 4 and 12 weeks on follow up were compared. Forty-three individuals (47 DFU) with baseline HbA1c 11.6% and ulcer area 9.87 cm2 were enrolled. After 12 weeks, mean HbA1c was 7.2%, 17 ulcers closed (healed group) and 30 ulcers did not close (unhealed group). The median time to ulcer healing was 10 weeks. Individuals in the healed group had lower fasting blood glucose (P = .010), postprandial blood glucose (P = .006), and HbA1c at 4 weeks (P = .001), and 12 weeks (0.018) compared to the unhealed group. Cox-regression analysis that revealed lower baseline ulcer area (P = .013) and HbA1c at 4 weeks (P = .009) significantly predicted DFU healing by 12 weeks. Baseline ulcer area of >10.58 cm2 and HbA1c at 4 weeks of >8.15% predicted delayed DFU healing. In conclusion, early and intensive glycemic control in the first 4 weeks of treatment initiation is associated with greater healing of DFU independent of initial ulcer area.

Long-term effect of anal fistula plug treatment on postoperative anal function in patients with trans-sphincteric perianal fistula and risk factors associated with anal function

Objective: To evaluate the long-term effects of anal fistula plug treatment on postoperative anal function in patients with trans-sphincteric perianal fistula, and identify risk factors associated with anal function. Methods: A case-control study was conducted. Clinical and follow-up data of 123 patients with trans-sphincteric perianal fistula receiving anal fistula plug treatment in Beijing Chaoyang Hospital from August 2008 to September 2012 were retrospectively analyzed. The follow-up deadline was April 30, 2020. The Wexner score for incontinence was used to evaluate pre-and postoperative anal function (range from 0 to 20, with higher score representing worse function). The potential risk factors affecting postoperative anal function, including gender, age, fasting blood glucose, diabetes, smoking, alcoholism, location of external opening of anal fistula, surgeon expertise and operation time, were statistically analyzed. Results: Among the 123 patients, 114 were male and 9 were female, the median age was 39 (15-69) years, body mass index (BMI) was (26.2±3.9) kg/m(2), and the median distance between the external opening of anal fistula and the anal verge was 2.6 (1.0-5.0) cm. The median operation time was 30.4 (15.0-60.0) minutes. The median follow-up time was 120 (93-141) months. Sixty-nine patients (56.5%) were healed. The assessment of anal function by Wexner incontinence score showed that 33 (26.8%) patients had anal functional decline after surgery, and the postoperative median Wexner score was 1.34 (0-8), which was significantly higher than preoperative score of 0.17 (0-4) (Z=-5.057, P<0.001). Compared with preoperative levers, postoperative subscores of flatus incontinence, liquid incontinence, solid incontinence and alteration in lifestyle were increased significantly (all P<0.05). Subgroup analysis showed that both in the healed and unhealed groups, the postoperative Wexner scores were higher than those before surgery [healed group: 1.22 (0-8) vs. 0.17 (0-1), Z=-3.796, P<0.001; unhealed group: 1.5 (0-8) vs.0.17 (0-3), Z=-3.422, P=0.001]. Univariate analysis revealed that 33 patients with postoperative anal functional decline had higher BMI, higher fasting blood glucose, higher proportion of alcoholism, longer distance between external opening of anal fistula and the anal verge, and longer operation time (all P<0.05). Multivariate logistic regression analysis testified that higher BMI (OR=1.485, 95% CI: 1.220-1.807, P<0.001) and longer distance between external opening and anal verge (OR=2.207, 95% CI: 1.276-3.220, P=0.003) were independent risk factors for postoperative anal functional decline. Conclusions: The treatment for trans-sphincteric anal fistula with anal fistula plug leads to long-term postoperative anal function decline. For patients with obesity and longer distance between external opening of anal fistula and the anal verge, this procedure should be performed with particular caution, and the anal sphincter should be preserved as much as possible during the operation.

Amino acids and wound healing in people with limb-threatening diabetic foot ulcers

BackgroundAmino acids are associated with wound healing in traumatic wounds and burns, although their effects on healing in patients with diabetic foot ulcers (DFUs) are limited. This study aimed to evaluate and identify specific amino acids associated with healing outcomes of patients with DFUs. MethodsSixty-two out of 85 patients who completed the in-hospital treatment for limb-threatening DFUs were enrolled. All ulcers had epithelialization without clinical evidence of infection at discharge. The patients and their families were instructed on foot-care techniques and committed to regular follow-up for 1 year. Baseline characteristics, PEDIS wound classification, laboratory data and serum amino acid levels were used to analyze their predictive power. ResultsFifty-seven patients completed the study in which 38 had healed and 19 had unhealed ulcers. The unhealed group had higher incidence of coronary artery disease and larger wound size. Most patients received endovascular therapy (81.6% healed group; 78.9% unhealed group) before enrollment. Following adjustments for clinical factors, the serum levels of arginine (326.4 μmol/L vs. 245.0 μmol/L, P = 0.045), isoleucine (166.7 μmol/L vs. 130.1 μmol/L, P = 0.019), leucine (325.8 μmol/L vs. 248.9 μmol/L, P = 0.039), and threonine (186.7 μmol/L vs. 152.0 μmol/L, P = 0.019) were significantly higher in the healed group. ConclusionsThe amino acids associated with wound healing in DFUs differ from those reported for traditional traumatic wounds. These findings affirm the necessity for future large-scaled studies for the application of these amino acids in DFU healing, either as prognostic predictors or supplemented regimens.

Evaluation of Healing After Medial Meniscal Root Repair Using Second-Look Arthroscopy, Clinical, and Radiological Criteria

Background: Previous studies have reported various healing rates (0%-100%) as evaluated by second-look arthroscopy after repair of medial meniscal root tears (MMRTs). Such variable results might provoke suspicion of the necessity for repair. Furthermore, the effect of meniscal healing on the clinical outcomes has not been reported. Purpose: To more precisely determine the healing rate of MMRTs repaired through the transseptal portal, which could provide objective visualization of the healed meniscus, and to identify the effect of meniscal healing on the clinical and radiological outcomes. Study Design: Case series; Level of evidence, 4. Methods: Between June 2010 and April 2015, 56 patients underwent pullout suture for MMRT. Lysholm score, Hospital for Special Surgery score, International Knee Documentation Committee subjective score, medial joint space height, and Kellgren-Lawrence (K-L) grade were evaluated. Thirty-three patients underwent second-look arthroscopy and were divided into a “stable healed group” and “unhealed group” according to their healing status, as evaluated through the transseptal portal. The intraoperative, clinical, and radiological outcomes of the 2 groups were compared. Results: All other clinical outcomes improved. However, medial joint space became significantly narrower (P < .001), and 23 patients (41%) showed K-L grade progression. On the basis of second-look arthroscopy, 23 patients (69.7%) were classified into a stable healed group and 10 (30.3%) into a unhealed group. The stable healed group showed a higher Hospital for Special Surgery score (P = .023), International Knee Documentation Committee subjective score (P = .031), and successful microfracture rate (P = .023), with less progression of medial joint space narrowing (P < .001) and K-L grade (P < .001). Conclusion: Despite degenerative change progression, clinical outcomes were improved. The successful healing rate was 69.7% after repair of MMRTs. Compared with the unhealed group, the stable healed group showed better clinical outcomes and less degenerative change progression.

3D-MRI combined with signal-to-noise ratio measurement can improve the diagnostic accuracy and sensitivity in evaluating meniscal healing status after meniscal repair.

This study compared the diagnostic accuracy of second-look arthroscopy, clinical assessment, and magnetic resonance imaging (MRI) in evaluating meniscal healing following repair. To explore the application of 3D-MRI sequences with signal-to-noise ratio (SNR) measurements and the analysis of sensitivity and accuracy in evaluating meniscal healing status after meniscal repair. This study included 75 patients (75 menisci; mean age, 25.4 ± 6.6years) who underwent arthroscopic meniscal repair (medial menisci, 45; and lateral menisci, 29). Follow-up evaluation included clinical assessment, magnetic resonance imaging (MRI), and second-look arthroscopy (mean follow-up, 10.2 ± 3.4months). The criteria defined for unhealed menisci were: on arthroscopy, presence of cleft; on clinical assessment, presence of joint-line tenderness, swelling, locking, or positive McMurray test; on MRI, grade III signal intensity at the site of repair. Finally, the SNR on 3D-MRI of the healed and the unhealed groups were compared. On second-look arthroscopy, 68 (90.7%) menisci were found to be completely healed. With the arthroscopic healing rate as the standard, the clinical healing rate was 69.3% (63 menisci) [sensitivity, 85.7%; specificity, 75.0%; accuracy, 76.0%; positive predictive value (PPV), 26.1%; negative predictive value (NPV), 98.1%]. Similarly, the sensitivity, specificity, accuracy, PPV and NPV, respectively, for MRI in four sequences were as follows: 2D-T2W-Sag: 71.4, 79.4, 78.7, 26.3, and 96.4%; 2D-T2W-Cor: 71.4, 82.4, 81.3, 29.4, and 96.6%; 3D-PDW-Sag: 100.0, 50.0, 54.7, 17.1, and 100.0%; 3D-PDW-Cor: 100.0, 58.8, 62.7, 20.0, and 100.0%. The mean SNRs of the healed group (3D-PDW-Sag, 66.7 ± 11.9; 3D-PDW-Cor, 63.9 ± 12.4) were significantly lesser than that of the unhealed group (3D-PDW-Sag, 89.2 ± 9.6; 3D-PDW-Cor, 82.2 ± 18.5) (P < 0.05). Identifying grade 3 meniscal damage on 3D-PDW images prior to applying the different SNR cut-off points revealed SNR values 80 in the sagittal plane and 70 in the coronal plane as having better diagnostic accuracy and sensitivity. The clinical relevance of the study was that 3D-MRI combined with SNR measurement may be a noninvasive and accurate method of assessment clinically, and a reliable alternative to second-look arthroscopy. III.

Analysis of risk factors of pressure ulcer healing

Objective To investigate the risk factors of wound healing 30 days after treatment in patients with pressure ulcer. Methods Two hundred and forty-five hospitalized patients with pressure ulcer between January 2015 and October 2016 were selected. They were divided into the healed group and the unhealed group 30 days after the treatment. The influencing factors 13 indexes including age, gender, edema, the number of diseases, the number of pressure ulcer, the size of pressure ulcer, PUSH score (Pressure Ulcer Scale Healing), hemoglobin, serum albumin, low density lipoprotein cholesterol and blood homocysteine underwent single factor and Logistic regression analysis. Results Single factor analysis of 12 indicators of risk factors affecting healing were age, Hb, Alb, Hcy, area of ulcer and PUSH scores of the 6 indicators in the regression equation (Z=3.11-6.63, All P < 0.01), gender also entered the regression equation (χ2 = 0.19, P < 0.01); further multivariate regression analysis showed that there were statistically significant differences in PUSH score index (χ2=10.47, P<0.01, OR=0.001, 95% confidence interval were 0.001-0.037). Conclusions Age, gender, Hb, Alb, Hcy and PU area were the risk factors of pressure ulcer healing. Key words: Pressure ulcer; Pressure ulcer scale healing; Wound healing; Regression analysis

Differences of RNA Expression in the Tendon According to Anatomic Outcomes in Rotator Cuff Repair

Background: Despite increased understanding of the pathophysiology of rotator cuff tears and the evolution of rotator cuff repair, healing failure remains a substantial problem. The critical roles played by biological factors have been emphasized, but little is known of the implications of gene expression profile differences at the time of repair. Purpose: To document the relationship between the perioperative gene expression of healed and unhealed rotator cuffs by RNA microarray analysis. Study Design: Case-control study; Level of evidence, 3. Methods: Superior (supraspinatus involvement) and posterosuperior (supraspinatus and infraspinatus involvement) tears were included in the study. Samples of rotator cuff tendons were prospectively collected during rotator cuff surgery. Three samples were harvested at the tendon ends of tears from the anterior, middle (apex), and posterior parts using an arthroscopic punch. Seven patients with an unhealed rotator cuff were matched one-to-one with patients with a healed rotator cuff by sex, age, tear size, and fatty degeneration of rotator cuff muscles. mRNA microarray analysis was used to identify genetic differences between healed and unhealed rotator cuff tendons. Gene ontology and gene association files were obtained from the Gene Ontology Consortium, and the Gene Ontology system in DAVID was used to identify enhanced biological processes. Results: Microarray analyses identified 262 genes that were differentially expressed by at least 1.5-fold between the healed and unhealed groups. Overall, in the healed group, 103 genes were significantly downregulated, and 159 were significantly upregulated. DAVID Functional Annotation Cluster analysis showed that in the healed group, the genes most upregulated were related to the G protein–coupled receptor protein signaling pathway and to the neurological system. On the other hand, the genes most downregulated were related to immune and inflammatory responses. BMP5 was the gene most upregulated in the healed group, and the majority of downregulated genes were involved in the immune/inflammatory response. Conclusion: The downregulation of inflammatory response genes and the upregulation of cell differentiation genes in torn rotator cuffs at the time of surgery are related to rotator cuff healing. These results provide useful baseline information for future biological studies on rotator cuff healing.

Natural history of extensive diaphragmatic injury on the right side: experimental study in rats.

To evaluate the natural healing of the rat diaphragm that suffered an extensive right penetrating injury. Animals were submitted to an extensive penetrating injury in right diaphragm. The sample consisted of 40 animals. The variables studied were initial weight, weight 21 days after surgery; healing of the diaphragm, non-healing of the diaphragm, and herniated abdominal contents into the chest. Ten animals were used as controls for weight and 30 animals were operated. Two animals died during the experiment, so 28 animals formed the operated group; healing of the diaphragm occurred in 15 animals (54%), 11 other animals showed diaphragmatic hernia (39%) and in two we observed only diaphragmatic injury without hernia (7%). Among the herniated organs, the liver was found in 100% of animals, followed by the omentum in 77%, small bowel in 62%, colon in 46%, stomach in 31% and spleen in 15%. The control group and the diaphragmatic healing subgroup showed increased weight since the beginning of the study and the 21 days after surgery (p <0.001). The unhealed group showed no change in weight (p = 0.228). there is a predominance of spontaneous healing in the right diaphragm; animals in which there was no healing of the diaphragm did not gain weight, and the liver was the organ present in 100% the diaphragmatic surface in all rats with healed diaphragm or not.

Characterization of grade 3 MRI signals following meniscal repair

Objective To explore the diagnostic value of grade 3 MRI signals in assessment of meniscal healing by comparing the differences in grade 3 MRI signals between healed and unhealed meniscus.Methods From March 2007 to December 2008,39 patients (41 menisci) received arthroscopic repair of the ruptured meniscus.They were 29 men and 10 women,with a mean age of 25.8 ± 6.8 years.They underwent MRI examination and second arthroscopy at 17.7 ± 3.3 months postoperation.According to the results of the second arthroscopy,they were divided into a healed group (27 cases and 29 menisci) and an unhealed group (12 cases and 12 menisci).The depth,length,width and intensity of grade 3 MRI signals at the repaired site were compared between the 2 groups.Results The grade 3 signals were still observed in 79.3％ (23/29) of the menisci in the healed group.The depth ratio (postoperative/preoperative) in the unhealed group (PD:81.0％ ± 41.3％,T2:62.8％ ± 42.5％) was significantly higher than that (PD:32.3％ ± 33.3％,T2:21.3％ ±33.7％) in the healed group (P ＜0.05).The width (2.2 ± 0.8 mmversus 1.0 ± 0.6 mm) and intensity in the unhealed group was significantly higher than in the healed group(P ＜ 0.05).Besides,the signalintensityofthehealedmeniscuswassignificantlylowerthanthepreoperativelevel(P ＜0.05).No significant differences were found in terms of the signal length between the 2 groups(P ＞ 0.05).Conclusions Changes in the width and intensity of grade 3 MRI signals following meniscal repair helps a lot the clinical diagnosis of healed and unhealed menisci.The decreased width and intensity of grade 3 MRI signals indicate healing of the meniscus. Key words: Menisci, tibial; Magnetic resonance imaging; Arthroscopy; Signal

Repair Integrity and Functional Outcomes for Arthroscopic Margin Convergence of Rotator Cuff Tears

We evaluated the clinical outcomes of arthroscopic margin convergence for rotator cuff tears. Twenty-four consecutive patients with full-thickness rotator cuff tears, in which the free tendon edge could not be reduced to the footprint after the release and mobilization of the rotator cuff tendon, were included. Rotator cuff repair integrity was determined by magnetic resonance imaging or ultrasonography after the operation. The mean age and follow-up period for the patients were 59.6 years (range, forty-eight to seventy-three years) and 30.6 months (range, twenty-four to sixty months), respectively. Five outcome measures were used before surgery and at the time of the final follow-up: a visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California Los Angeles (UCLA), the Constant-Murley score, and the range of shoulder motion. The follow-up rate for imaging was 95.8%, and the follow-up rate for clinical evaluation was 91.7%. The mean UCLA score (and standard deviation) improved from 17.4 ± 5.5 preoperatively to 31.6 ± 4.0 at the time of the final follow-up (p < 0.001). The mean ASES score improved from 54.9 ± 23.3 to 91.3 ± 11.8, respectively (p < 0.001). The mean Constant-Murley score improved from 45.9 ± 17.6 to 79.1 ± 12.6 (p < 0.001). The mean VAS score improved from 6.5 ± 1.7 to 1.3 ± 1.5 (p < 0.001). The mean range of motion (forward flexion) improved from 117.9° ± 37.7° to 166.8° ± 16.7° (p < 0.001). The postoperative imaging examinations showed cuff integrity without a retear in 52.2% of the shoulders. However, the UCLA, ASES, and Constant-Murley scores were not significantly different between healed and unhealed groups (p = 0.800, p = 0.322, and p = 0.597, respectively). Reducing tension by margin convergence followed by a repair of the resulting free edge to bone has reasonable short-term clinical results but a substantial retear rate (47.8%). However, the retears tended to be smaller than the original tear size. No significant difference was observed in the short-term clinical results between the groups with or without a retear.

Analysis of 131I therapy and correlation factors of Graves’ disease patients

To analyze the correlation therapeutic effects of first sufficiency ¹³¹I therapy in Graves' disease patients and improve its one-time curative ratio. Seven hundred and sixty-six patients (age range 12-77 years, mean 40.46 ± 13.12 years), including 237 men (range 12-77 years, 40.98 ± 12.64 years) and 529 women (range 14-75 years, 40.22 ± 13.34 years), who received the first I treatment were studied. The relevant examinations were performed before ¹³¹I therapy: the maximal radioactive iodine uptake of thyroid (RAIUmax), the effective half-life (EHL), the ultrasound of thyroid to calculate its weight, thyroid imaging with single-photon emission computed tomography and serum-free triiodothyronine (FT₃), free thyroxine (FT₄), sensitive thyroid-stimulating hormone (sTSH), anti-thyrotrophin receptor antibody (TRAb), thyroid-stimulating immunoglobulin, thyroglobulin antibody (TgAb), and anti-thyroid microsome antibody (TMAb). After the ¹³¹I dosage was determined, all the patients took ¹³¹I once orally. The ¹³¹I dosage range was 74-592 MBq (221.63 ± 100.64 MBq). A clinical and laboratory assessment was performed at 1, 3, 6, and 12 months after ¹³¹I therapy. Patients were divided into the clinically recovered group (symptoms and signs disappeared, free thyroid hormone levels were within or below the normal range, and sTSH was within or above the normal range) and the clinically unhealed group (symptoms and signs disappeared partially, free thyroid hormone levels were still above the normal range or within the normal range for a time and then increased again, and sTSH was constantly below the normal range). Data were analyzed by the unpaired t-test, the independent samples t-test, the χ² test, logistic regression, and Pearson bivariate correlation. The one-time curative ratio of ¹³¹I therapy was 78.7% (including euthyroidism and hypothyroidism). Multiplicity in healing patients fit the logistic regression equation. The accuracy of discrimination of the equation was 79.5%. The influential factors of ¹³¹I therapy were age, RAIUmax, EHL, TRAb, and TgAb. RAIUmax and EHL were the protecting factors. Age, TRAb, and TgAb were the risk factors. TRAb influenced the one-time curative ratio between patients with negative and positive TRAb, which was higher in men (2.836 times) than in women (1.438 times). ¹³¹I therapy is an effective intervention for Graves' disease. The higher the RAIUmax and (or) the longer the EHL, the higher the possibility of a one-time cure. Elder patients or patients with a positive TRAb and (or) TgAb have a lower possibility of a one-time cure. Women with a positive TRAb should be administered an increased ¹³¹I dose to improve the curative effect.

Analysis of Function and Predictors of Failure in Women Undergoing Repair of Crohn’s Related Rectovaginal Fistula

PurposeCrohn’s-related rectovaginal fistulae have significant impact on quality of life including sexual function. The aim of this study was to obtain long-term follow-up of Crohn’s related rectovaginal fistulae to assess variables that influence surgical success and determine its effects on quality of life and sexual function. MethodsAll women with Crohn’s-related rectovaginal fistulas who underwent surgical repair from 1997 to 2007 were contacted for long-term follow-up. Variables assessed were age, body mass index, smoking, presence of active Crohn’s disease, type of surgical procedure performed, use of perioperative seton or stoma, number of previous procedures, time interval between last repair and current repair, use of immunomodulators, and steroids. SF-12, Fecal Incontinence Quality-of-Life Scale, and Female Sexual Function Index were used to assess quality of life and sexual function. Multivariable logistic regression model was used to identify variables associated with surgical failure. ResultsSixty-five women were identified at median follow-up of 44.6 months (interquartiles, 13.1–79.1) of which 30 patients (46.2%) were successfully healed. Methods of repair included advancement flap (n = 47), episioproctotomy (n = 8), colo-anal anastomosis (n = 7), and fibrin glue or plug (n = 3). Twenty-eight women (43.1%) were sexually active at follow-up, and of those, nine complained of dyspareunia, all within the unhealed group of patients. On multivariate analysis, only immunomodulators were associated with successful healing (p = 0.009). Smoking and steroids were associated with failure (p = 0.04). Sexual function and quality-of-life scores were comparable between healed and unhealed groups. ConclusionsCrohn’s-related rectovaginal fistulae are difficult to treat. Healing increased with use of immunomodulators; however, smoking and steroids were predictors of failure. Dyspareunia was higher in unhealed women.