Unilateral Reduction Research Articles

The Incidence of Malignant and High-Risk Pathology Findings in Postreduction Mammaplasty Patients.

Introduction: Reduction mammaplasty is often performed to alleviate symptoms of macromastia or for symmetry after a lumpectomy in the contra-lateral breast. Abnormal pathology including breast cancer can be incidentally found in reduction mammaplasty specimens, but there is no consensus on risk factors or detection rates. This study aimed to elucidate the incidence of malignant and high-risk pathology findings in patients undergoing breast reduction in a Canadian context. Methods: We conducted a retrospective review of all reduction mammaplasty cases performed by 5 surgeons between January 2001 and May 2023. Patients were categorized into Group A, those undergoing bilateral reduction for macromastia symptoms, and Group B, those with a history of breast-conserving surgery seeking unilateral reduction postlumpectomy. Results: In total, 1383 breasts from 872 patients were examined: 1022 in Group A and 361 in Group B. Group B was significantly older (56.9 ± 9.3 vs 44.0 ± 13.9 years) whereas Group A had a significantly higher BMI (33.1 ± 8.4 vs 30.1 ± 5.8). High-risk and malignant pathology incidence was 1.4% overall. The sole malignancy detected was in a patient in Group A without prior breast cancer history. Multivariate analysis revealed BMI as a significant predictor for high-risk pathologies (OR 1.134, 95% CI [1.012-1.271]). Conclusions: Our findings align with previously reported incidence rates of pathological findings in mammaplasty specimens and highlight the correlation between BMI and pathology risk. These results underscore the importance of a comprehensive history and preoperative counselling about the possibility of further treatment following pathological discoveries during reduction mammaplasty.

Minimally Invasive Placement of Cannulated Headless Compression Screws for Reduction of Sacroiliac Luxation in 14 Cats.

To describe percutaneous fluoroscopy-guided placement of self-drilling, self-tapping, 3.0 mm cannulated headless compression screws (HCS) for surgical reduction of sacroiliac luxation (SIL) in cats, and to document clinical outcome. Medical records of cats with SIL, managed by percutaneous fluoroscopy-guided placement of a 3.0 mm HCS, were reviewed. Short-term outcome was assessed by clinical examination and radiographs. Long-term outcome was assessed using an owner questionnaire. A total of 14 cats, with 17 SIL (11 unilateral and 3 bilateral), were included. Mean postoperative sacroiliac joint reduction was 85%, median sacral purchase was 63% for unilateral and 38% for bilateral HCS, and pelvic canal diameter ratio and hemipelvic canal width ratio were satisfactory in all cases. At follow-up, all cats exhibited satisfactory clinical improvement. Radiographic assessment revealed no implant-related complications of the unilateral HCS; however, screw loosening was observed in 3/6 of bilateral HCS. Owner satisfaction was good, with 10/11 of owners being very satisfied and 1/11 being satisfied. Percutaneous fluoroscopy-guided placement of a 3.0 mm HCS is a safe and effective method for unilateral surgical reduction of SIL in cats. Further studies are needed to establish the most appropriate procedure to treat bilateral SIL.

Asymmetrical Damage of the Wrist Joint Induces Lateralized Cortical Bone Loss in the Metacarpal Diaphysis in Patients with Rheumatoid Arthritis.

Background/Objectives: Osteoporosis is common in rheumatoid arthritis (RA), occurring either systemically or locally around inflamed joints. Decreased metacarpal bone density is a known marker of RA progression and hand function impairment. Although RA is generally characterized by symmetrical arthritis, some patients exhibit asymmetrical joint involvement. This study investigates the frequency of unilateral metacarpal bone density reduction in RA patients and aims to identify associated factors. Methods: This study included 143 RA patients (107 females, mean age 62.4 yrs., mean disease duration 11.1 yrs.). Bilateral hand X-rays were used to measure the cortical thickness rate (CTR) of the 2nd to 4th metacarpals. Unilateral bone density reduction was defined as a thin-to-thick-side CTR ratio (CTRR) < 0.8. Associations between CTR reduction and unilateral wrist joint damage (WJD) were analyzed. Results: Unilateral CTR reduction (CTRR < 0.8) was observed in 16.8% of patients, significantly associated with unilateral WJD. Among patients with unilateral WJD, 50.0% showed CTRR lateral (+) compared to 10.1% without unilateral WJD (p < 0.01). ANCOVA revealed significant effects of WJD laterality on CTRR, with an interaction effect showing greater CTRR laterality when thin-side WJD was present without thick-side WJD. Post-biologic treatment, CTR values decreased in both hands, indicating no improvement in bone density reduction. Conclusions: Approximately 17% of RA patients exhibited unilateral relative metacarpal bone density reduction, closely associated with unilateral WJD. This first detailed report on bone density laterality in RA underscores the need for early intervention and rehabilitation strategies in RA patients with hand involvement.

Lateralized Subthalamic Stimulation for Axial Dysfunction in Parkinson's Disease: Exploratory Outcomes and Open-Label Extension.

A randomized trial suggested that reducing left-sided subthalamic stimulation amplitude could improve axial dysfunction. To explore open-label tolerability and associations between trial outcomes and asymmetry data. We collected adverse events in trial participants treated with open-label lateralized settings for ≥3 months. We explored associations between trial outcomes, location of stimulation and motor asymmetry. 14/17 participants tolerated unilateral amplitude reduction (left-sided = 10, right-sided = 4). Two hundred eighty-four left-sided and 1113 right-sided stimulated voxels were associated with faster gait velocity, 81 left-sided and 22 right-sided stimulated voxels were associated with slower gait velocity. Amplitude reduction contralateral to shorter step length was associated with 2.4-point reduction in axial MDS-UPDRS. Reduction contralateral to longer step length was associated with 10-point increase in MDS-UPDRS. Left-sided amplitude reduction is potentially more tolerable than right-sided amplitude reduction. Right-sided more than left-sided stimulation could be associated with faster gait velocity. Shortened step length might reflect contralateral overstimulation.

Swyer–James–Macleod syndrome mimicking pulmonary embolism in adults: a case report

BackgroundSwyer–James–MacLeod syndrome (SJMS) is a rare lung condition characterized by a unilateral lung hyperlucency and reduction in the pulmonary vasculature, with or without the presence of bronchiectasis. In the 1950s, Swyer, James, and Macleod simultaneously characterized the syndrome for the first time. It is typically diagnosed in childhood. Adult-onset cases are extremely rare, with little literature available on its clinical presentation and diagnostic challenges. Swyer–James–MacLeod syndrome can mimic other lung disorders, resulting in misdiagnosis and improper treatment.Case presentationA 49- year-old woman from Debre Berhan, Ethiopia, presented to the emergency department of Hakim Gizaw Teaching Hospital with symptoms and radiographic findings mimicking acute pulmonary embolism. On the basis of the clinical presentation and radiographic findings, the patient was first treated as a probable case of pulmonary embolism. Anticoagulant therapy and oxygen support were initiated. Nevertheless, additional testing using a chest computed tomography angiography revealed left lung hyperlucency, decreased vascularity, bronchiectasis, and a negative result for pulmonary embolism. As a result, Swyer–James–MacLeod syndrome was diagnosed.ConclusionThe symptoms of Swyer–James–MacLeod syndrome can be mistaken for pulmonary embolism, which could lead to ineffective treatment and needless expenses. In individuals presenting with symptoms suggestive of pulmonary embolism, this case emphasizes the significance of considering Swyer–James–MacLeod syndrome as a differential diagnosis, especially in the absence of established risk factors for pulmonary embolism.

Twenty four-month follow-up after bullectomy, unilateral and bilateral lung volume reduction surgery: a single-center retrospective analysis of consecutive cases

PurposeWhile pharmacologic therapy remains the cornerstone of lung emphysema treatment, surgery is an additional therapeutic option in selected patient groups with advanced emphysema. The aim of lung volume reduction surgery (LVRS) is to improve lung function, exercise capacity, quality of life and survival. We sought to determine the therapeutic value of surgical resection in specific patients with lung emphysema.Patients and methodsA retrospective study was performed consisting of 58 patients with lung emphysema who underwent surgical intervention over a 10-year period and were followed for 2 years postoperatively. The clinical characteristics recorded were FEV1 (forced expiratory volume in 1 s), the 6-min walk test (6-MWT), the Modified Medical Research Council (mMRC), body mass index (BMI) and quality of life prior to and 6, 12 and 24 months after surgical intervention. Moreover, all peri- and post-operative complications were noted.ResultsOut of 58 emphysema patients (72% male, FEV1 (L) 2.21 ± 0.17, RV (L) 3.39 ± 0.55), 19 underwent surgical bullectomy, 31 unilateral LVRS and 8 sequential bilateral LVRS. Six months after surgery, there was a statistically significant improvement in FEV1, RV, TLC, 6-MWT and mMRC. Over a period of 12 to 24 months postoperatively, clinical benefit gradually declines most likely due to COPD progression but patients still experienced a significant improvement in FEV1. The most common postoperative complications were persistent air leakage (> 7 days), arrhythmia and subcutaneous emphysema in 60%, 51.6% and 22.4%, respectively. No deaths were observed after surgical intervention.ConclusionIn a selected patient population, surgery led to significant improvement of lung function parameters, exercise capacity and quality of life. Over a period of 12 to 24 months postoperatively, clinical benefit gradually decreased most likely due to COPD progression.

Diaphragmatic dysfunction is associated with postoperative pulmonary complications and phrenic nerve paresis in patients undergoing thoracic surgery

PurposeWe aimed to quantify perioperative changes in diaphragmatic function and phrenic nerve conduction in patients undergoing routine thoracic surgery.MethodsA prospective observational study was performed in patients undergoing esophageal resection or pulmonary lobectomy. Examinations were carried out the day prior to surgery, 3 days and 10–14 days after surgery. Endpoints for diaphragmatic function included ultrasonographic measurements of diaphragmatic excursion and thickening fraction. Endpoints for phrenic nerve conduction included baseline-to-peak amplitude, peak-to-peak amplitude, and transmission delay. Measurements were assessed on both the surgical side and the non-surgical side of the thorax.ResultsForty patients were included in the study. Significant reductions in diaphragmatic excursion were seen on the surgical side of the thorax for all excursion measures (posterior part of the right hemidiaphragm, p < 0.001; hemidiaphragmatic top point, p < 0.001; change in intrathoracic area, p < 0.001). Significant changes were seen for all phrenic nerve measures (baseline-to-peak amplitude, p < 0.001; peak-to-peak amplitude, p < 0.001; transmission delay, p = 0.041) on the surgical side. However, significant changes were also seen on the non-surgical side for all phrenic nerve measures (baseline-to-peak amplitude, p < 0.001; peak-to-peak amplitude, p < 0.001; transmission delay, p = 0.022). A postoperative reduction in posterior diaphragmatic excursion of more than 50% was significantly associated with postoperative pulmonary complications (coefficient: 2.69 (95% CI [1.38, 4.01], p < 0.001).ConclusionThoracic surgery caused a significant unilateral reduction in diaphragmatic excursion on the surgical side of the thorax, which was accompanied by significant changes in phrenic nerve conduction. However, phrenic nerve conduction was also significantly affected on the non-surgical side to a lesser extent, which was not mirrored in diaphragmatic excursion. Our findings suggest that phrenic nerve paresis plays a role in postoperative diaphragmatic dysfunction, which may be a contributing factor in the pathogenesis of postoperative pulmonary complications.Clinical trials registration numberNCT04507594.

Dynamic visual acuity screening test results analysis of 25 patients with peripheral vertigo

Objective:To observe the results of dynamic visual acuity screening tests in patients with peripheral vertigo and explore its clinical significance. Methods:The number of 48 healthy volunteers were enrolled as control group and 25 peripheral vertigo patients as experimental group. In the experimental group, there are 12 patients with vestibular neuritis, 1 patient with Hunt syndrome, 5 patients with sudden deafness with vertigo and 7 patients with bilateral vestibular dysfunction. Horizontal and vertical dynamic visual acuity screening tests were performed on them. The number of lost rows of horizontal and vertical dynamic visual acuity was compared between the control group and the experimental group to figure out if there is a statistical difference. The number of lost rows of horizontal and vertical dynamic visual acuity was compared within the experimental group to figure out if there is a statistical difference. The two groups of 18 cases of unilateral vestibular function decline and 7 cases of bilateral vestibular function decline in the experimental group were compared with the control group, and figure out if there is a statistical difference. Results:The median number of lost rows of horizontal dynamic visual acuity in 48 healthy volunteers was 1.5 and median number of lost rows of vertical dynamic visual acuity was 1.0 in the control group. The median number of lost rows of horizontal dynamic visual acuity of 26 healthy volunteers was 6 and median number of lost rows of vertical dynamic visual acuity was 5 in the experimental group. Compared to the experimental group, the number of lost rows both have statistical significance in horizontal and vertical dynamic visual acuity（P<0.01）. The comparison of horizontal and vertical lost rows within the test group also have statistical significance（P<0.01）. Twenty five patients with exceptional vestibular disease in the experimental group were divided into unilateral vestibular function reduction group（n=18） and bilateral vestibular function reduction group（n=7）. Compared with the control group, there was significant differences in the number of horizontal and vertical lost rows（P<0.01） within the three groups. After pairwise comparison, the number of lost rows of horizontal and vertical in the control group was significantly lower than that in the unilateral vestibular function reduction group and the bilateral vestibular function reduction group（P<0.01）. There was a highly significant correlation between the number of horizontally lost rows of DVA and the mean vHIT values of bilateral horizontal semicircular canals in 25 patients（P<0.01）; and a highly significant correlation between the number of vertically lost rows of DVA and the mean vHIT values of vertical semicircular canals in 4 groups bilaterally（P<0.01）. Conclusion:The Dynamic Visual Acuity Screening Test is a useful addition to existing tests of peripheral vestibular function, particularly the vHIT test, and provides a rapid assessment of the extent of 2 Hz VOR impairment in patients with reduced vestibular function.

Modified patient-specific surgical-guide-assisted precise treatment of unilateral comminuted zygomaticomaxillary complex fractures: A 5-year retrospective study

Our study aimed to evaluate modified patient-specific surgical-guide-assisted precise treatment of unilateral comminuted zygomaticomaxillary complex (ZMC) fractures.The retrospective non-randomized study was conducted in a single hospital in China. All patients diagnosed with unilateral comminuted ZMC fractures between January 1, 2018 and December 31, 2022 were retrospectively reviewed. All patients underwent preoperative spiral computed tomography (CT). CT data were processed using software to DICOM format and transferred to Proplan CMF3.0 for preoperative virtual surgical planning and postoperative evaluation. All data were extracted from standardized electronic medical records. All statistical analyses were performed using SPSS version 20.0. The chi-square test and t-test were used for statistical analyses.The 54 included patients were divided into two comparable, equal cohorts of 27 patients, and followed up for at least 6 months. Fracture reduction was assisted using the modified patient-specific surgical guides in the guide group (23 males, four females; mean age 37.74 ± 12.07 years) and without the modified patient-specific surgical guides in the control group (20 males, seven females; mean age 37.44 ± 13.58 years).In the guide group, the mean eminence deviation between the affected and unaffected sides was 1.01 ± 0.92 mm, and the mean width deviation between the affected and unaffected sides was 1.29 ± 1.32 mm. In the control group, the mean eminence deviation between the affected and unaffected sides was 1.99 ± 1.69 mm, and the mean width deviation between the affected and unaffected sides was 2.68 ± 2.01 mm. The differences in facial protrusion (p = 0.001) and width (p = 0.003) symmetry between the affected and healthy sides of the two groups were statistically significant (p < 0.05).In conclusion, applying the modified patient-specific surgical guides to unilateral comminuted zygomaticomaxillary complex fracture reduction has the advantages of greater predictability and effectiveness, and improved bilateral ZMC symmetry. It should be noted that this approach would be especially beneficial for less-experienced surgeons.

Clinical management of a nonoptimal vault and unexpected postoperative refraction in a patient implanted with a phakic intraocular lens

Introduction: This case reports the management of a bilateral toric implantable collamer lens (ICL) surgery with low vaulting and unilateral reduction in visual acuity (VA) associated with a combined effect of surgically induced astigmatism (SIA) and toric-ICL rotation. This case expands the common management of toric-ICL rotation, by adding surgically induced corneal changes. Patient and Clinical Findings: The patient presented with moderate myopia and high astigmatism and was implanted with a toric-ICL, resulting in bilateral low vault &lt;150 μm and unilateral VA reduction (20/40) because of postoperative oblique astigmatism, observed at the 4-week follow-up. Diagnosis, Intervention and Outcomes: The low ICL vaulting was associated with a high crystalline lens rise and underestimation of the sulcus-to-sulcus distance. The VA reduction resulted from a combined effect of ∼1.0 diopter SIA and 8-degree ICL rotation. The authors associate the high SIA to abnormal corneal biomechanics indexes and the toric-ICL rotation to a lack of stability resultant from a small ICL size. The left eye toric-ICL has exchanged with one with larger size and the power recalculated using vectorial analysis. The toric-ICL exchange increased the vault 75 μm and improved VA. Conclusions: Detailed anterior chamber morphometry and corneal biomechanics may assist in improving the refractive outcome in toric-ICL surgery.

Comparison of breathing pattern and diaphragmatic motion in patients with unilateral cervical radiculopathy and asymptomatic group

BackgroundThe associations between neck pain and respiratory dysfunction were clarified in patients with neck pain. There is dearth of evidence on pulmonary dysfunction and diaphragmatic excursion in patients with unilateral cervical radiculopathy (CR). The purpose of this study was to compare the breathing pattern and diaphragmatic excursion in patients with unilateral CR with those in an asymptomatic group.MethodsTwenty-five patients with unilateral CR and 25 asymptomatic individuals aged between 30 and 55 participated in this study. Diaphragmatic motion, breathing pattern, active cervical range of motion and kinesiophobia were investigated in both groups by using fluoroscopy, manual assessment of respiratory motion (MARM), cervical range of motion device, and Tampa scale of kinesiophobia. Statistical significance was set at 0.05.ResultsNo statistically significant differences were found between the two groups with regard to sex, age and body mass index. The mean excursion of the hemi diaphragm on the involved side (the side of CR) was significantly lower than that on the uninvolved side in patients with unilateral CR with a large effect size. The excursion of the involved hemi diaphragm in patients was reduced compared to the matched hemi diaphragm in the control group. There was no significant difference between the hemi diaphragms excursion in the control group. The results of the MARM variables showed that the volume of breathing and the percentage rib cage motion in normal and deep breathing were significantly different between the two groups, but there was no significant difference in the balance of breathing between the two groups. Additionally, the active cervical range of motion was reduced in these patients in comparison to the control group, and it was less on the involved side than on the uninvolved side.ConclusionThe results of this study revealed a dysfunctional breathing pattern in normal and deep breathing and a unilateral reduction in diaphragmatic excursion on the side of radiculopathy in patients with unilateral CR compared to the control group.

Unilateral Pediculectomy and Reduction with Short-Segment Pedicle Screw Fixation for Thoracolumbar Burst Fracture: A Case Series

This study aimed to evaluate the efficacy of unilateral pediculectomy and reduction with short-segment pedicle screw fixation for thoracolumbar burst fracture. We retrospectively reviewed patients who underwent a unilateral pediculectomy and reduction with short-segment fixation and interbody fusion for thoracolumbar burst fracture. The unilateral pediculectomy created sufficient space to approach the ventral side of the spinal cord for removing bone fragments and insertion of an interbody cage to correct kyphosis. Lumbar lordosis (LL), pelvic incidence (PI) minus LL, and segmental Cobb angle were measured at 3 time points: preoperatively, postoperatively, and final follow-up. Furthermore, sagittal vertical axis (SVA) was measured to assess global sagittal balance at the final follow-up. A total of 10 patients, with a mean age of 39.8±21.0, underwent the surgical procedure. All patients had a thoracolumbar injury classification and severity score > 5. The mean follow-up period was 15.8±13.9months. The mean postoperative LL (46.0±5.8) was significantly higher (P=0.008) than the preoperative measurement (32.8±8.2). The mean postoperative PI minus LL (2.2±8.4) was not significantly lower (P=0.051) than preoperative measurement (15.4±12.6). The mean postoperative segmental Cobb angle (11.4±8.4) was significantly higher (P<0.001) than the preoperative measurement (-11.6±10.9). At the final follow-up, the mean sagittal vertical axiswas 10.0±28.8mm. Unilateral pediculectomy and reduction with short-segment fixation and interbody fusion served as an efficient surgical method for thoracolumbar burst fracture.

18F]-FDopa positron emission tomography imaging in corticobasal syndrome.

First, to investigate the patterns of [18F]-FDOPA positron emission tomography imaging in corticobasal syndrome using visual and semi-quantitative analysis and to compare them with patterns found in Parkinson's disease and progressive supranuclear palsy. Then, to search for correlations with clinical features and [18F]-FDG positron emission tomography imaging. 27 corticobasal syndrome patients who underwent [18F]-FDOPA positron emission tomography imaging were retrospectively studied. They were compared to 27 matched Parkinson's disease patients, 12 progressive supranuclear palsy patients and 53 normal controls. Scans were visually assigned to one of the following patterns: normal; unilateral homogeneous striatal uptake reduction; putamen uptake reduction with putamen-caudate gradient. A semi-quantitative analysis of striatal regional uptake and asymmetry was performed and correlated to clinical features and [18F]-FDG positron emission tomography patterns. [18F]-FDOPA positron emission tomography appeared visually abnormal in only 33.5% of corticobasal syndrome patients. However, semi-quantitative analysis found putaminal asymmetry in 63%. Striatal uptake was homogeneously reduced in both putamen and caudate nucleus in corticobasal syndrome patients unlike in Parkinson's disease and progressive supranuclear palsy. No correlation was found between [18F]-FDOPA positron emission tomography and clinical features. Half of corticobasal syndrome patients presented a corticobasal degeneration pattern on [18F]-FDG positron emission tomography. CONCLUSION: [18F]-FDOPA positron emission tomography can often be normal in corticobasal syndrome patients. Semi-quantitative analysis is useful to unmask a significant asymmetry in many of them. Homogeneous striatal uptake reduction contralateral to the clinical signs is highly suggestive of corticobasal syndrome. This finding can be helpful to better characterize this syndrome with respect to Parkinson's disease and progressive supranuclear palsy.

Maxillary sinus volume and facial asymmetry after unilateral zygomaticomaxillary complex fracture reduction with 2, 3, and 4 fixation points: CBCT-based investigation

PurposeThis study aimed to assess the maxillary sinus volume (MSV), Chronic Sinusitis incidence, and asymmetry of the zygomaticomaxillary complex (ZMC) following ZMC fracture surgery with various numbers of fixation points. Materials and methodsIn a prospective non-randomized cohort, 50 adults with unilateral ZMC fractures who treated by open reduction and internal fixation (ORIF) between November 2019 and October 2021 were assigned to accomplish this study. They distributed into three groups as per fixation points (2, 3, or 4 Points). Preoperative (T1), Immediate postoperative (T2), and follow-up (T3) cone beam computed topography were analyzed using the Mimics software. The main measures were MSV and asymmetry indexes (ASI) of six paired bilateral anatomical landmarks (Orbital, Suprajugal, Jugale, Zygon, Maxillozygion 1, and Maxillozygion 2). ResultsMSV decreased significantly on the affected sides postoperatively in 2P and 3P groups, both in T2 and T3. Further, the T2-T3 comparisons showed a significant MSV change (p = 0.001). ASI reduced considerably to clinically tolerated levels (<3 mm) on landmarks near the fixation sites postoperatively. The ASI on the Zygon and Maxillozygion 1 landmarks showed significant changes among the three groups in both T2 and T3. Interestingly, only five cases had reported postoperative sinusitis symptoms. ConclusionsAlthough the MSV was changed among the different fixation point groups, the incidence of chronic sinusitis was uncommon. Bilateral asymmetry affected by number and position of the fixation points, fixation with 4 points provide more symmetry.

Could Mini-Trampoline Training Be Considered as a New Strategy to Reduce Asymmetries?

Inter-limb asymmetry is defined as the performance imbalance of a limb with respect to the other one. Studies demonstrated how plyometric training could minimize inter-limb imbalance by reducing asymmetries and the relative risk of musculoskeletal injuries. Among the different plyometric training modalities, SuperJump® represented a reliable method. This study aimed to evaluate the acute effects of SuperJump® training on dynamic balance Unilateral Asymmetry and Bilateral Asymmetry Indexes. Thirty-seven subjects were randomly allocated in two groups: SuperJump® (N = 20) and Control (N = 17). The SuperJump® group participated in the SuperJump® session, whereas the Control group did not receive any workout session. Before (PRE) and after (POST) the SuperJump® session, both groups performed the Wobble Board balance test. A significant difference (p &lt; 0.003) between the SuperJump® in POST and Control groups in PRE intervention for dominant leg was found. No significant differences (p &gt; 0.05) emerged between groups in testing time on Bilateral Asymmetry Index. Significant differences (p = 0.005) between PRE and POST in the SuperJump® group and an 18.9% Unilateral Asymmetry Index threshold reduction for the subjects were found. A strong relationship (R2 = 0.79) between delta (∆) change Unilateral Asymmetry Index and Unilateral Asymmetry Index baseline parameters was tested. Lastly, no significant differences (p &gt; 0.05) in Unilateral Asymmetry Indexes between the Bilateral Asymmetry equal and change categories in the SuperJump® group was found. In conclusion, SuperJump® training played a key role in reducing Unilateral Asymmetry Index.

Analysis of the Curative Effect of Temporomandibular Joint Disc Release and Fixation Combined with Chitosan Injection in the Treatment of Temporomandibular Joint Osteoarthrosis

Temporomandibular joint osteoarthritis (TMJ-OA) is common in clinic. The purpose of this study was to evaluate the efficacy of disc release, fixation and chitosan injection in the treatment of TMJ-OA. From March 2021 to March 2022, 32 patients who underwent the unilateral reduction and fixation of temporomandibular joint disc release were retrospectively studied. All patients were diagnosed with TMJ-OA and were treated with chitosan injection. This group of patients was analyzed by the visual analog scale (VAS) for pain and improvement of maximum comfortable mouth opening before treatment and 6 months after treatment. A paired t-test was used to evaluate the treatment effect, and p < 0.05 indicated that the difference was statistically significant. All 32 patients were successfully treated by surgery and chitosan injection in the second week after operation. The duration of disease in this group ranged from 1 to 10 months, with an average of 5.7 months. After 6 months of follow up, 30 patients were satisfied with the treatment and two were unsatisfied. The difference in the treatment effect was found to be statistically significant (p < 0.05). Temporomandibular joint disc release and fixation combined with chitosan injection is effective in the treatment of TMJ-OA.

Mastectomy is a safe procedure in transgender men with a history of breast reduction

Little is known about the safety and surgical outcomes of mastectomy after breast reduction in the trans male population. Several concerns have been voiced that performing mastectomy with prior breast reduction surgery, increases the risk for complications and revision surgery. All transgender men with a history of breast reduction, who underwent a mastectomy at our center between 01-1990 and 01-2021 were identified from our hospital registry. A retrospective chart study was conducted recording surgical characteristics, surgical complications, revision surgery, and clinical follow-up. A total of 1362 subcutaneous mastectomies were performed between 01-1990 and 01-2021. A total of 36 (2.6%) individuals were included (35 bilateral and 1 unilateral breast reduction). The mean age at mastectomy was 37 ± 10 years, and the median time between breast reduction and mastectomy was 6.3 years (range 1.0–31.1). Most individuals underwent a Wise-pattern breast reduction (91%) and a double incision mastectomy with free nipple grafts (86%). Following mastectomy, one acute reoperation was performed because of hemorrhage (3%). Partial pedicled nipple necrosis was seen in 7% and (partial) non-take of nipple grafts in 4%. Scar revisions were performed in 9%, dogear corrections in 20%, and both nipple corrections, and contour corrections in 6%. When comparing the outcomes in literature for surgical complications, scar revision, contour correction or nipple areolar complex revision, no clear disadvantage seems to be present when performing mastectomy after breast reduction. Mastectomy is a safe procedure in transgender men with a history of breast reduction.

Seasonal Hyperacute Panuveitis (SHAPU) in Bhutan

ABSTRACT Purpose To report the first series of Seasonal Hyperacute Pan Uveitis (SHAPU) from Bhutan. Methods We retrospectively analyzed the patients with clinically diagnosed SHAPU treated in the referral center in the last 5 years. Data included demographics (age, sex, laterality), region, time of presentation (year, season) and treatment received. Results The series included 3 males and 2 females. The mean age was 16 years. Three patients had presented in autumn of 2021, and two in autumn of 2019. Four patients presented within 2 weeks of the onset of symptoms. All patients had either exposure or contact with white moths. All patients presented with unilateral sudden painless reduction in vision and low Intraocular pressure. Four patients required vitrectomy. The final visual acuity of 3 patients was >6/36, and one patient was 6/60. Conclusions and Importance The time of presentation and early treatment intervention are crucial in achieving good visual prognosis in SHAPU.

MEASUREMENT OF DIAPHRAGMATIC DYSFUNCTION AND PHRENIC NERVE PALSY IN PATIENTS UNDERGOING THORACIC SURGERY FOR LUNG- OR ESOPHAGEAL CANCER

<h3>Introduction and Objective</h3> Thoracic surgery carries a substantial risk of postoperative pulmonary complications. Recent studies have shown that the risk of postoperative pulmonary complications is significantly higher in patients suffering from postoperative diaphragmatic dysfunction. Diaphragmatic dysfunction may be accompanied by phrenic nerve palsy. However, the extent of phrenic nerve palsy and its association with diaphragmatic dysfunction following thoracic surgery is unknown. Therefore, we aimed to quantify changes in diaphragmatic function and phrenic nerve conductance in patients undergoing thoracic surgery for lung- or esophageal cancer using ultrasonographic measures and phrenic nerve conduction studies. <h3>Design and Methods</h3> This was a prospective observational study including patients scheduled for pulmonary lobectomy or esophageal resection. Examinations were carried out the day prior to surgery and respectively 3 days and 10-14 days after surgery. Endpoints for diaphragmatic function included ultrasonographic measurements of diaphragmatic excursion of the posterior part of the right hemidiaphragm, excursion of the hemidiaphragmatic top point, change in intrathoracic area and diaphragmatic thickening fraction. Ultrasonographic measurements were recorded during a standardized respiration cycle. Endpoints for phrenic nerve conductance included baseline-to-peak amplitude, peak-to-peak amplitude and transmission delay of the diaphragmatic compound muscle action potential (CMAP). Measurements for both diaphragmatic- and phrenic nerve recordings were assessed for both the surgical side and the non-surgical side of the thorax and thus measured over time. <h3>Results</h3> We included 40 patients of which 13 had pulmonary lobectomies and 27 had esophageal resections performed. Significant reductions in diaphragmatic excursion were seen on the surgical side of the thorax for all excursion measures (posterior part of the right hemidiaphragm, p < 0.001; hemidiaphragmatic top point, p < 0.001; change in intrathoracic area, p < 0.001) (Figure 1). Conversely, all ultrasound excursion measures did not change significantly on the non-surgical side. Diaphragmatic thickening fraction did not change significantly on either side. For phrenic nerve measures, significant reductions were seen for both CMAP amplitude measures on the surgical side (baseline-to-peak, p < 0.001; peak-to-peak, p < 0.001) and non-surgical side (baseline-to-peak, p < 0.001; peak-to-peak, p < 0.001). Transmission delay also changed significantly between assessments on both the surgical (p =0.041) and the non-surgical side (p =0.021) (Figure 2). <h3>Conclusion</h3> Thoracic surgery caused a significant unilateral reduction in diaphragmatic excursion on the surgical side of the thorax, whereas the contralateral hemidiaphragm's excursion did not decrease significantly. Diaphragmatic compound muscle action potential amplitude was reduced significantly bilaterally. Therefore, our findings show that a postoperative reduction in diaphragmatic excursion is accompanied by partial phrenic nerve palsy, which may be a contributing factor in the pathogenesis of postoperative pulmonary complications.

Cerebral blood flow-single-photon emission computed tomography and Brodmann mapping may facilitate the evaluation of clinical features of early-onset Alzheimer’s disease

A relatively large numbers of studies have reported on the clinical features, classifications, and impairment of cerebral blood flow (CBF) in cases with Alzheimer’s disease. However, only few reports have investigated the relationships between clinical tests and lesion areas in the brain with significantly reduced CBF, assessed using single-photon emission computed tomography (SPECT). This study aimed to assess the correlations between impaired Mini-Mental State Examination (MMSE) scores and reduced CBF using Brodmann area mapping and classify early-onset Alzheimer’s disease (EOAD). Thirty-one patients aged &lt;65 years, with memory impairment, were examined using CBF-SPECT, and MMSE during the same period. Twenty patients were diagnosed with EOAD. We divided the patients into two groups: one with bilateral reduction of CBF in temporo-parietal region and the other with unilateral reduction. The bilateral group had significantly lower MMSE scores than the unilateral reduction group, but it had significantly less family history, significantly poor prognoses, and ten significantly reduced CBF in the Brodmann area (BA) with SPECT. In the bilateral group, there were large correlations between impaired MMSE and reduced CBF regions in the BA. These findings confirm that the classification of EOAD may pave the way to understand patients with EOAD.