ABSTRACT
The objective of this study is to compare the clinical outcomes after arthroscopic hip labral repair in athletes and non-athletes. The design of this study is a retrospective comparative ...study. The setting of this study is an institutional study. One hundred and sixteen patients of hip labral tears who underwent arthroscopic labral repair were included. Eighty-five of these patients met the inclusion/exclusion criteria (25 athletes and 60 non-athletes). Hip labral tears underwent arthroscopic labral repair. The main outcome measures are as follows: visual analog scale (VAS) and modified Harris Hip Score (mHHS) 2 years postoperatively and the rate of return to sports at previous level. There was no significant difference in the gender, alpha angle, lateral center-edge angle between the two groups, except for the mean age (19.3 versus 42.2, P < 0.001), Marx activity rating scale (MARS) (14.6 versus 6.8, P < 0.001) and University of California, Los Angeles (UCLA) activity rating scale (9.6 versus 5.0, P < 0.001). The intraoperative findings were similar in the two groups. The VAS scores and mHHS both showed a significant improvement after surgery in both groups (VAS improvement 3.6 and mHHS improvement 22.4 in the athlete group; VAS improvement 3.9 and mHHS improvement 25.0 in the non-athlete group, all P < 0.001). There was no difference in VAS improvement or mHHS improvement between the athlete and non-athlete groups. All the patients in the athlete group return to sports at previous level 6 months after the operation. The mean time of return to sports at previous level was 5.4 months. Both athletes and non-athletes demonstrate significant VAS and mHHS improvement following arthroscopic labral repair. The VAS scores improvement and mHHS improvement were similar in the athlete and non-athlete groups after arthroscopic labral repair.
Purpose: We prospectively assessed 22 consecutively treated patients to determine the effectiveness and safety of arthroscopically assisted posterior cruciate ligament (PCL) reconstruction by using a ...quadriceps tendon autograft. Methods: Twenty-two patients with isolated PCL injury who underwent PCL reconstruction with a quadriceps tendon autograft were enrolled in the prospective study. The average follow-up period was 66 months (range, 60-76). Follow-up included Lysholm knee scores, Tegner activity scores, International Knee Documentation Committee (IKDC) score, thigh muscle assessment, and radiographic assessment. Results: The mean preoperative Lysholm score for 22 knees was 67 (range, 50 to 75), and the mean postoperative Lysholm score was 89 (range, 75 to 98). Nineteen of 22 patients (86%) displayed good or excellent results in the final assessment. The mean preoperative Tegner score for 22 knees was 3 (range, 2 to 5), whereas the mean postoperative Tegner score was 6 (range, 3 to 9). There were statistically significant improvements in Lysholm score ( P = .009), Tegner score ( P = .039), postoperative KT-1000 arthrometer (MEDmetric, San Diego, CA) scores ( P = .006), final IKDC rating ( P = .035), and thigh atrophy and muscle strength ( P < .05) when compared with preoperative data. Regarding IKDC final rating, 82% of the patients (18 of 22) were assessed as normal or nearly normal (grade A or B). Conclusions: After follow-up for more than 60 months, the analytical results showed patients achieved satisfactory function after PCL reconstruction by using a quadriceps tendon–patellar bone autograft. This study suggests that a quadriceps tendon autograft is sufficiently large and strong and can achieve good ligament function after reconstruction. Level of Evidence: Level IV, therapeutic study.
Plastic and reconstructive surgery relies on the knowledge of angiosomes in the raising of microsurgical flaps. Growing interest in muscle-sparing perforator flaps calls for reliable methods to ...assess the clinical feasibility of new donor sites in anatomical studies. Several injection techniques are known for the evaluation of vascular territories. Indocyanine green–based fluorescence angiography has found wide application in the clinical assessment of tissue perfusion. In this article, the use of indocyanine green–based fluorescence angiography for the assessment of perforasomes in anatomical studies is described for the first time.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
To describe a novel system workflow to design and manufacture patient-specific three-dimensional (3D) printing jigs for single-stage skull bone tumor excision and reconstruction and to present ...surgical outcomes of 14 patients.
A specific computer-aided design/computer-aided manufacturing software and hardware system was set up, including a virtual surgical planning subsystem and a 3D printing–associated manufacturing subsystem. Computed tomography data of the patient's skull were used for 3D rendering of the skull and tumor. The output of patient-specific designing included a 3D printing guide for tumor resection and a 3D printing model of the bone defect after tumor excision. A polymethyl methacrylate implant was fabricated preoperatively and used for repair.
The specific 3D printing guide was used to design intraoperative jigs and implants for 14 patients (age range, 1–72 years) with skull bone tumors. In all cases, the cutting jig allowed precise excision of tumor and bone, and implants were exact fits for the defects created. All operative results were successful, without intraoperative or postoperative complications. Postoperative computed tomography scans were obtained for analysis. Postoperative 3D measurement of the skull symmetry index (cranial vault asymmetry index) showed significant improvement of head contour after surgery.
The computer-aided design/computer-aided manufacturing system described allows definitive preoperative planning and fabrication for treatment of skull bone tumors. Apparent benefits of the method include more accurate determination of surgical margins and better oncological outcomes.
Purpose
In the setting of acetabular dysplasia, the increased translational motion of the femur may damage the labrum and cartilage, as well as stretch the capsule. The purpose of the study was to ...investigate the relationship between the acetabular coverage and the capsular stiffness by assessing the distension of anterior and posterior joint recesses on the hip computed tomography arthrography.
Methods
One hundred thirty-three patients (138 hips) with a median age of 36 years (range 18–50 years) who received the computed tomography arthrography for evaluation of nonarthritic hip pain in our institute between 2015 and 2017 were retrospectively reviewed. The maximal distance between the anterior/posterior capsule and the anterior femoral head–neck junction/posterior femoral head on the axial imaging of computed tomography arthrography was defined as the width of anterior/posterior joint recess. The width of anterior/posterior joint recess was adjusted with the diameter of the femoral head and was then compared between acetabular dysplasia (lateral center–edge angle < 25°), normal acetabulum (lateral center–edge angle between 25 and 39°), and deep acetabulum (lateral center–edge angle > 39°). In addition, the standard univariate linear regression analysis was used to investigate the relationship between the adjusted width of anterior/posterior joint recess and anterior/posterior coverage of the hip, determined by the anterior/posterior wall index.
Results
The adjusted width of posterior joint recess was significantly greater in the acetabular dysplasia group than the normal acetabulum and deep acetabulum groups (
p
< 0.01 and
p
= 0.02, respectively). There was no significant difference of the adjusted width of anterior joint recess between the groups (n.s.). The adjusted width of posterior joint recess had a significant but weak negative correlation with the anterior wall index (
r
= − 0.25,
p
< 0.001), and no correlation with the posterior wall index (
r
= − 0.0004, n.s.). There was no significant correlation between the adjusted width of anterior joint recess and the anterior/posterior wall index (
r
= 0.05, n.s./
r
= 0.07, n.s.).
Conclusions
The distension of posterior capsule on the computed tomography arthrography was significantly greater in acetabular dysplasia. In addition, there was a significant but weak negative correlation between the distension of posterior capsule and the anterior coverage of the hip. It indicated a looser posterior capsule was observed in a dysplastic hip. The relevance of posterior capsular laxity to clinical outcomes warrants further investigation. Given the fact that the distension of anterior capsule was not significantly higher in acetabular dysplasia, the need of anterior capsular plication in a dysplastic hip should be carefully evaluated.
Level of evidence
Level III.
Hepatocellular carcinoma (HCC) metastasizes to the mandible is infrequently seen. Solitary bony metastasis to the mandible is rarer. The intractable bleeding caused by rupture of the metastatic HCC ...is challenging to clinicians. We present a case of a 74-year-old woman with HCC under control without progression for 3 years. Left facial swelling and episodes of bleeding developed recently and biopsy revealed a metastatic HCC. Computer tomography showed a large tumor in parapharyngeal space with evident mandibular ramus destruction. Bleeding occurred from the metastatic tumor but could not be controlled by electrocauterization, Surgical, tissue glue, and bone wax and angiographic embolization. Palliative radiotherapy (2400 cGy in 6 fractions) was tried and the intractable bleeding was successfully stopped after the radiotherapy. Because of the hypervascular and osteolytic nature of the solitary mandibular metastatic lesion, the bleeding was troublesome. Radiotherapy provided successful control of intractable bleeding from the metastatic tumor.
Trigonometric formulae have been derived to correlate the distraction angle (height) and tibial specifications. However, the assumption-induced simplifications are inherent in the formulae such as ...the rigid tibia and the specific orientations of cutting plane and lateral hinge. This study aimed to evaluated the accuracy of the trigonometric formulae.
The 3D printed tibiae were used as the specimens for which the hinge orientations and distraction sites were systematically varied. Hinge orientation was determined by wedge inclination of the bone saw into the medial tibia and saw progression near the lateral cortex. The specimens were distracted at different distraction sites to measure the distraction angles that were compared with literature formulae.
In cases of the same distraction height, the wedge inclination, saw progression, and distraction site had various impacts on the coronal angles, indicating that the ideal formula should consider these parameters. Averagely, the predicted angles of the literature formulae were 15% higher than the testing results. The differences in these results may be attributed to the deformable property of the specimen material, non-ideal hinge orientation, and differences in distraction sites. Saw progression and distraction site had greater impacts than wedge inclination on the distraction angle.
Variations in three surgical indices constitute a complicated mechanism that affects the 3D hinged rotation of the distracted plateau. The non-middle distraction further deforms the tibial rotation and reduces the accuracy of the trigonometric formulae. The trigonometric formulae might underestimate the distraction angle; thus. Appropriate corrections are necessary for clinical application.
•Saw progression and distraction sit had greater impacts on the distraction angle.•The predicted angles of trigonometric formulae were 15% higher than the testing results.•The formulae underestimate the distraction angle and appropriate corrections are necessary.
This study investigates whether baseline 18F-FDG PET radiomic features can predict survival outcomes in patients with diffuse large B-cell lymphoma (DLBCL). We retrospectively enrolled 83 patients ...diagnosed with DLBCL who underwent 18F-FDG PET scans before treatment. The patients were divided into the training cohort (n = 58) and the validation cohort (n = 25). Eighty radiomic features were extracted from the PET images for each patient. Least absolute shrinkage and selection operator regression were used to reduce the dimensionality within radiomic features. Cox proportional hazards model was used to determine the prognostic factors for progression-free survival (PFS) and overall survival (OS). A prognostic stratification model was built in the training cohort and validated in the validation cohort using Kaplan–Meier survival analysis. In the training cohort, run length non-uniformity (RLN), extracted from a gray level run length matrix (GLRLM), was independently associated with PFS (hazard ratio (HR) = 15.7, p = 0.007) and OS (HR = 8.64, p = 0.040). The International Prognostic Index was an independent prognostic factor for OS (HR = 2.63, p = 0.049). A prognostic stratification model was devised based on both risk factors, which allowed identification of three risk groups for PFS and OS in the training (p < 0.001 and p < 0.001) and validation (p < 0.001 and p = 0.020) cohorts. Our results indicate that the baseline 18F-FDG PET radiomic feature, RLNGLRLM, is an independent prognostic factor for survival outcomes. Furthermore, we propose a prognostic stratification model that may enable tailored therapeutic strategies for patients with DLBCL.
Activated cardiac apoptosis was found in hearts from hypertensive animals, but little information regarding the effects of exercise training on cardiac apoptosis in hypertension is available. The ...purpose of this study was to evaluate the anti-apoptotic and pro-survival effects of exercise training on hypertensive hearts.
28 spontaneously hypertensive rats were divided into sedentary group (SHR) or underwent running exercise on treadmill for 1 h/day, 5 sessions/wk, for 12 wk (SHR-EX). Fourteen age-matched Wistar Kyoto rats served as a sedentary normotensive group (WKY). After exercise training or sedentary status, the excised hearts were measured by hemotoxylin and eosin staining, terminal deoxynucleotidyl transferase dUTP-mediated nick-end labeling (TUNEL) assay, and Western blotting.
Fewer TUNEL-positive apoptotic cells were in SHR-EX groups than those in SHR. Protein levels of Fas ligand, Fas death receptor, tumor necrosis factor (TNF)-α, TNF receptor 1, Fas-associated death domain (FADD), activated caspase-8, and activated caspase-3 (Fas-dependent apoptotic pathways), as well as Bid, t-Bid, Bad, p-Bad, Bak, cytochrome c, activated caspase 9, and activated caspase-3 (mitochondria-dependent apoptotic pathways) were decreased in the SHR-EX group compared with the SHR group. Protein levels of IGF-1, IGF-1R, p-PI3K, p-Akt, p-Bad, and Bcl2 (cardiac pro-survival pathway) become more activated in SHR-EX groups than SHR and WKY.
Exercise training prevented hypertension-enhanced cardiac Fas-dependent and mitochondria-dependent apoptotic pathways and enhanced cardiac pro-survival pathway in rat models. Our findings demonstrate new therapeutic effects of exercise training on hypertensive hearts for preventing apoptosis and enhancing survival.
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