bluuebunny/crossref_metadata_2025 huggingface dataset:
Better PROMs and higher return-to-sport rate after modular bicompartmental knee arthroplasty than after total knee arthroplasty for medial and patellofemoral compartment osteoarthritis
Authors: Deng Wang , Shao Hongyi , Tang Hao , Tang Qiheng , Wang Zhaolun , Yang Dejin , Zhou Yixin
Published: January 2023

Background

Theoretical advantages of bicompartmental knee arthroplasty (BKA) over total knee arthroplasty (TKA) for bicompartmental (medial combined with patellofemoral) osteoarthritis (OA) are still unclear. This study aimed to compare patient-reported outcome measures (PROMs) and return-to-sport (RTS) rate between modular BKA and TKA in early follow-up.

Methods

Twenty-five consecutive modular BKA cases with a minimum 2-year follow-up were matched with 50 TKA cases at 1:2 ratio. Demographic data and preoperative functional scores, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Scores (KSSs), were analyzed to ensure comparability. Postoperative WOMAC score, KSS, range of motion (ROM), Forgotten Joint Score-12 (FJS-12), and RTS rates were compared. Operative time and blood loss were also analyzed.

Results

Significant differences in the WOMAC-function (median 97.1 vs. 89.7, p < 0.001) and KSS-function (median 90.0 vs. 80.0, p = 0.003) scores were identified between the BKA and TKA groups. ROM was significantly greater in the BKA group than in the TKA group (median 125.0° vs. 120.0°, p = 0.004), in addition to the FJS-12 (median 89.6 vs. 53.1, p < 0.001). The overall RTS rate was significantly higher in the BKA group than in the TKA group (71.6% vs. 56.5%, p = 0.039). Operative time was significantly longer in the BKA group than in the TKA group (median 105.0 vs. 67.5 min, p < 0.001), but blood loss was similar (median 557.6 vs. 450.7 ml, p = 0.334).

Conclusion

Modular BKA demonstrated better functional recovery, better joint perception, and higher RTS rate than TKA; thus, modular BKA can be a good alternative for bicompartmental OA.
Influence on emergency digit replantation and outcome assessment after COVID-19 virus nucleic acid testing normalization
Authors: Zhang Kunqi , Zhang Rui , Li Shanyu , Liu Shenghe , Wang Feiyan , Xu Jia , Kang Qinglin
Published: January 2023

Objective

The study aims to compare the implementation and prognosis of emergency digit replantation surgery before and after normalized corona virus disease 2019 (COVID-19) nucleic acid testing for patients taking emergency operation and to explore the influence of normalized COVID-19 nucleic acid testing on replantation surgery.

Method

Normalized COVID-19 nucleic acid testing for patients taking emergency operation has been carried out since 1 August 2021 at our hospital, which means each patient who needs emergency surgical treatment has to obtain either positive or negative results of COVID-19 nucleic acid before entering the operating room. This research reviewed and compared the prognosis of the injured extremity that had emergency severed digit replantation between June and September 2021, at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and analyzed the impact of normalized COVID-19 nucleic acid testing on the outcome of the replanted fingers of different severity using disability of arm-shoulder-hand (DASH) and hand injury severity scoring (HISS) scoring systems.

Results

A total of 54 cases with 74 severed replanted phalanges were included replanted by the research group between 1 August and 30 September 2021, without any COVID-19 suspected/confirmed case detected. Compared with previous period (1 June to 31 July, 2021), although the interval between emergency visits and emergency replantation did increase significantly after normalized COVID-19 nucleic acid testing [(3.83 ± 0.94) to (1.77 ± 0.67) h, P < 0.05], we observed no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively (P = 0.538) nor in the complication rate (P = 0.344). Moreover, there was no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively in patients with different traumatic severities before and after normalized COVID-19 nucleic acid testing (moderate P = 0.269, severe P = 0.055, major P = 0.149).

Conclusion

Despite the preoperative delay, the policy of COVID-19 nucleic acid testing normalization does not have explicit influence on the short-term outcomes of emergency digit replantation surgery. With this evidence, microsurgeons could pay attention to the patients' anxiety and spend more effort in comforting them during the prolonged preoperative wait. These insights may have implications for other emergency department resource management whenever a social crisis occurs.
Application of femoral nerve block combined with modified swelling anesthesia in high ligation and stripping of great saphenous vein
Authors: Chen Xiaobin , Liu Zhenwen , Zhou Binbin , Fan Zuyou , Zhao Hu , Lin Chen
Published: January 2023

Background

To analyze and explore the clinical efficacy of ultrasound guided femoral nerve block combined with modified swelling anesthetic solution in high ligation and stripping of the great saphenous vein.

Methods

90 patients with varicose great saphenous vein of lower limbs undergoing high ligation and stripping of great saphenous vein were randomly divided into group A (femoral nerve block combined with modified swelling anesthesia), group B (simple swelling anesthesia) and group C (epidural anesthesia), with 30 patients in each group. The serum CRP level, operation duration, intraoperative blood loss, postoperative hospitalization time, total hospitalization cost, postoperative VAS score, preoperative and postoperative VCSS score, intraoperative mean arterial pressure and heart rate, postoperative related complications, and patients, satisfaction with diagnosis and treatment were compared among the three groups.

Results

There was no significant difference in operation duration, intraoperative blood loss, postoperative complications, and preoperative and postoperative VCSS scores among the three groups (P > 0.05). The postoperative hospitalization time, postoperative VAS score and total hospitalization cost of patients in group A and B were lower than those in group C, and the postoperative hospitalization time and postoperative VAS score in group A were more significant (P < 0.05). Compared with group B, the fluctuation range of intraoperative mean arterial pressure and heart rate, and postoperative serum CRP level in group A and C were lower, especially in group A (P < 0.05). The three groups of patients were followed up regularly after surgery. The results showed that the number of postoperative complications in group A was lower than that in the other two groups (P < 0.05), and the postoperative complications of the three groups were effectively relieved after symptomatic treatment (dressing change, anti-infection, taking drugs to improve circulation, etc.). The satisfaction of patients in group A was significantly higher than that in groups B and C (P < 0.05).

Conclusions

Ultrasound guided femoral nerve block combined with modified swelling anesthetic solution applied in high ligation and stripping of the great saphenous vein can significantly improve postoperative inflammatory stress reaction of patients, effectively ensure the safety and reliability of surgical progress, help to improve analgesia effect and accelerate physical rehabilitation, and has short hospitalization time, low medical cost, and high satisfaction of patients' diagnosis and treatment, which is worthy of widespread clinical promotion and reference.
Prognostic and clinicopathological value of the geriatric nutritional risk index in gastric cancer: A meta-analysis of 5,834 patients
Authors: He Liang , Li Ying , Qu Linlin , Zhang Fan
Published: January 2023

Background

Recent studies have explored the prognostic value of the geriatric nutritional risk index (GNRI) in patients with gastric cancer (GC), but the results are controversial. We aimed to systemically identify the association between the GNRI and prognosis in GC using a meta-analysis.

Methods

The databases of PubMed, Web of Science, Cochrane Library, and Embase were searched until September 25, 2022. Pooled hazard ratios and the corresponding 95% confidence intervals (CIs) were used to estimate the prognostic value of the GNRI in GC. Odds ratios (ORs) and 95% CIs were used to assess the correlation between the GNRI and clinicopathological characteristics of GC.

Results

Ten studies including 5,834 patients with GC were included in this meta-analysis. The merged results indicated that a low pretreatment GNRI was associated with inferior overall survival (hazard ratio = 1.21, 95% CI = 1.12–1.30, P < 0.001) and worse cancer-specific survival (hazard ratio = 2.21, 95% CI = 1.75–2.80, P < 0.001) for GC. Moreover, a low GNRI was significantly associated with an advanced pathological stage (OR = 2.27, 95% CI = 1.33–3.85, P = 0.003), presence of adjuvant chemotherapy (OR = 1.25, 95% CI = 1.01–1.55, P = 0.040), and tumor location in the lower stomach (OR = 1.33, 95% CI = 1.06–1.65, P = 0.012) in GC. However, there was no significant association between GNRI and sex, tumor differentiation, or lymph node metastasis in patients with GC.

Conclusion

Our meta-analysis identified that the pretreatment GNRI level was a significant prognostic factor for patients with GC. A low GNRI is associated with worse overall survival and inferior cancer-specific survival in patients with GC.
Branchial cleft cyst arising in posterior mediastinum: A case report
Authors: Li Lin-Jie , Han Zhi-Feng , Shang Sheng-Tao
Published: January 2023

Branchial cleft cysts are congenital diseases of the neck caused by abnormal embryonic development of the first to fourth branchial clefts. Most branchial cleft cysts are found in the head and neck, but branchial cleft cysts arising in posterior mediastinum are rarely reported. We report a 44-year-old Chinese man who was found to have a right-posterior mediastinal mass on chest computed tomography (CT) during a physical examination. The size of the mass was about 30.6 mm * 25.1 mm and enhanced CT of the chest showed an occupying lesion in the right parietal esophagus of the upper-posterior mediastinum with no significant enhancement. The patient was considered to have a neurogenic tumor with cystic change and underwent posterior mediastinal tumor resection. Postoperatively, pathological examination confirmed the final diagnosis of bronchial cleft cyst. The patient was discharged on the 7th day after surgery. One year postsurgery, no obvious recurrence was found in reexamination.
Effect of cervical suspensory traction in the treatment of severe cervical kyphotic deformity
Authors: Shengfa Pan , Hongyu Chen , Yu Sun , Fengshan Zhang , Li Zhang , Xin Chen , Yinze Diao , Yanbin Zhao , Feifei Zhou
Published: January 2023

Objective

This study aimed to investigate a new noninvasive traction method on the treatment of severe cervical kyphotic deformity.

Methods

The clinical data of patients with severe cervical kyphosis (Cobb > 40°) treated in Peking University Third Hospital from March 2004 to March 2020 were retrospectively summarized. 46 cases were enrolled, comprising 27 males and 19 females. Fifteen patients underwent skull traction, and 31 patients underwent suspensory traction. Among them, seven used combined traction after one week of suspensory traction. Bedside lateral radiographs were taken every two or three days during traction. The cervical kyphosis angle was measured on lateral radiographs in and extended position at each point in time. The correction rate and evaluated Japanese Orthopedic Association (JOA) scoring for the function of the spinal cord were also measured. The data before and after the operation were compared with paired sample t-test or Wilcoxon signed-rank test.

Results

No neurological deterioration occurred during the skull traction and the cervical suspensory traction. There were 12 patients with normal neurological function, and the JOA score of the other 34 patients improved from 11.5 ± 2.8 to 15.4 ± 1.8 at the end of follow up (P < 0.05). The average kyphotic Cobb angle was 66.1° ± 25.2, 28.7° ± 20.1 and 17.4° ± 25.7 pre-traction, pre-operative, and at the final follow-up, respectively (P < 0.05). The average correction rate of skull traction and suspensory traction was 34.2% and 60.6% respectively. Among these, the correction rate of patients with simple suspensory traction was 69.3%. For patients with a correction rate of less than 40% by suspensory traction, combined traction was continued, and the correction rates after suspensory traction and combined traction were 30.7% and 67.1% respectively.

Conclusions

Pre-correction by cervical suspensory traction can achieve good results for severe cervical kyphotic deformity, with no wound and an easy process. Combined traction is effective for supplemental traction after suspensory traction.
Clinical study to assess influence of immediate provisionalization and various implant morphologies on implant stability: A prospective clinical study
Authors: Qi Meiyao , Deng Shiyong , Tan Zhen
Published: January 2023

Introduction

The aim of this study was to evaluate the influence of different implant morphologies and immediate provisionalization options on the change of implant stability.

Methods

94 Patients were randomized to receive implants from Straumann® BL/Straumann® BLT/Astra OsseoSpeed® TX, meanwhile having the same opportunity to receive healing abutment or immediate provisionalization. Implant stability quotient (ISQ) and marginal bone loss (MBL) were recorded at following timepoints. Parametric statistic was used for data analysis.

Results

Data showed that ISQ and MBL values of conical/straight/straight with micro-thread neck implants had no significant difference.

Discussion

Immediate provisionalization options could move the dip point of ISQ values ahead or delayed around one week, which were also relevant to implant systems. MBL values were proved to be unaffected by both two factors mentioned above.
Evaluation of femoral head bone quality by Hounsfield units: A predictor of implant failure for intertrochanteric fractures after intramedullary nail fixation
Authors: Fan Jixing , Lv Yang , Xu Xiangyu , Zhou Fang , Zhang Zhishan , Tian Yun , Ji Hongquan , Guo Yan , Yang Zhongwei , Hou Guojin
Published: January 2023

Purpose

The aim of present study is to evaluate the femoral head bone quality by Hounsfield units and its relationship to the occurrence of implant failure for intertrochanteric fractures after intramedullary nail fixation.

Methods

This retrospective study assessed 160 intertrochanteric fractures treated with intramedullary fixation. Patients with and without implant failure were divided into failure and control groups, respectively. The demographic information, femoral head Hounsfield unit (HU) value, the reduction quality, status of posteromedial support and position of the screw/blade were collected and compared. The logistic regression analyses were performed to evaluate risk factors of implant failure in intertrochanteric fractures after intramedullary nail fixation.

Results

Of the patients, 15 (9.38%) suffered from implant failure after intramedullary fixation. The mean HU value of femoral head was much lower in the failure group than the control group (133.25 ± 34.10 vs. 166.12 ± 42.68, p = 0.004). And the univariate analyses showed that A3 fracture and poor reduction quality were associated with implant failure (p < 0.05). After adjustment for confounding variables, the multivariable logistic regression analyzes showed that femoral head HU value (odds ratio [OR], 0.972; 95% CI, 0.952–0.993; p = 0.008) and poor reduction quality (OR, 7.614; 95% CI, 1.390–41.717; p = 0.019) were independent influencing factors for implant failure.

Conclusion

The femoral head HU value was significantly correlated with the incidence of implant failure and can be used as an independent factor to predict implant failure for intertrochanteric fractures after intramedullary fixation.
Treatment of avulsion fracture of posterior cruciate ligament tibial insertion by minimally invasive approach in posterior medial knee
Authors: Guo Huihui , Zhao Yao , Gao Liang , Wang Chen , Shang Xianbo , Fan Haitao , Cheng Wendan , Liu Chang
Published: January 2023

Objective

The study aims to explore the feasibility and clinical effect of posterior minimally invasive treatment of cruciate ligament tibial avulsion fracture.

Methods

Posterior knee minimally invasive approach was used to treat avulsion fracture of posterior cruciate ligament (PCL) tibia in 15 males and 11 females. The length of the incision, intraoperative blood loss, operation time, postoperative hospital stay, residual relaxation, and fracture healing time were analyzed to evaluate the curative effect, learning curve, and advantages of the new technology. Neurovascular complications were recorded. During the postoperative follow-up, the International Knee Joint Documentation Committee (IKDC), Lysholm knee joint score, and knee joint range of motion were recorded to evaluate the function.

Results

All 26 patients were followed up for 18–24 months, with an average of 24.42 ± 5.00 months. The incision length was 3–6 cm, with an average of 4.04 ± 0.82 cm. The intraoperative blood loss was about 45–60 ml, with an average of 48.85 ± 5.88 ml. The operation time was 39–64 min, with an average of 52.46 ± 7.64 min. The postoperative hospital stay was 2–5 days, with an average of 2.73 ± 0.87 days. All incisions healed grade I without neurovascular injury. All fractures healed well with an average healing time of 9.46 ± 1.33 weeks (range, 8–12 weeks). The Lysholm score of the affected knee was 89–98 (mean, 94.12 ± 2.49) at 12-month follow-up. The IKDC score was 87–95 with an average of 91.85 ± 2.19, and the knee range of motion was 129–148° with an average of 137.08 ± 5.59°. The residual relaxation was 1–3 mm, with an average of 1.46 ± 0.65 mm.

Conclusion

This minimally invasive method provides sufficient exposure for internal fixation of PCL tibial avulsion fractures without the surgical complications associated with traditional open surgical methods. The process is safe, less invasive, and does not require a long learning curve.
Debridement without bone grafting prevents osteolytic lesions progression in revision THAs with prosthesis revised
Authors: Kong Keyu , Li Fupeng , Qiao Hua , Chang Yongyun , Hu Yi , Li Huiwu , Zhang Jingwei
Published: January 2023

Background

Bone defects in revision total hip arthroplasties (rTHAs) caused by osteolysis are routinely treated with autografts or allografts, despite their various disadvantages. Currently, little is known about the prognosis of ungrafted cavities with complete debridement following prosthetic revision in rTHAs with component loosening, as few reports have focused on the application of debridement without bone grafting in osteolytic lesions that do not compromise structural stability in revision THAs with revised components.

Methods

In this study, 48 patients receiving rTHAs with components revised for aseptic loosening with osteolysis between 2015 and 2019 were included. Anteroposterior and lateral radiographs of hips before and after revision surgery and last follow-up were compared to measure whether the size of the debrided osteolytic cavity without bone graft had changed.

Results

In total, 48 patients with 59 osteolytic lesions were enrolled. The mean follow-up period was 3.33 years (range 2–6 years). None of the 59 cavities had progressed at the last follow-up, and 11 (18.6%) regressed. Two patients underwent re-revision according to dislocation during follow-up.

Conclusion

In rTHAs with revised components, osteolytic lesions that do not influence structural stability could be debrided without grafting to avoid the disadvantages of grafting. Debridement and component revision are sufficient to prevent the progression of osteolytic lesions during surgery, without having adverse effects on the short-to mid-term prognosis.
Monitoring of postoperative neutrophil-to-lymphocyte ratio, D-dimer, and CA153 in: Diagnostic value for recurrent and metastatic breast cancer
Authors: Ren Zhiyao , Yang Jing , Liang Jiahui , Xu Yunfeng , Lu Guanda , Han Yanxun , Zhu Jie , Tan Husheng , Xu Tao , Ren Min
Published: January 2023

Objective

This stydy aims to assess the value of monitoring of postoperative neutrophil-to-lymphocyte ratio (NLR), D-dimer, and carbohydrate antigen 153 (CA153) for diagnosis of breast cancer (BC) recurrence and metastasis.

Materials/Methods

A cohort of 252 BC patients who underwent surgery at the First Affiliated Hospital of Anhui Medical University between August 2008 and August 2018 were enrolled in this retrospective study. All patients were examined during outpatient follow-ups every 3 months for 5 years postoperation and every 6 months thereafter. Recurrence or metastasis was recorded for 131 patients but not for the remaining 121. Retrospective analysis of hematological parameters and clinicopathological characteristics allowed comparison between the two groups and evaluation of these parameters for the recurrent and metastatic patients.

Results

Lymph node metastasis, higher tumor node metastasis (TNM) staging, and higher histological grade correlated with BC recurrence and metastasis (p < 0.05). Statistical differences were found in absolute neutrophil count (ANC), absolute lymphocyte count (ALC), CEA, CA153, D-dimer, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) between the recurrent and metastatic and control groups (p < 0.05). Logistic regression analysis showed that CA153, D-dimer, NLR, and TNM staging were risk factors for BC recurrence and metastasis (p < 0.05). Combined values for the NLR, D-dimer, and CA153 had good diagnostic values, giving the highest area under the curve (AUC) of 0.913. High NLR, D-dimer, and CA153 values were significantly associated with recurrence and metastasis at multiple sites, lymph node metastasis, and higher TNM staging (p < 0.05). Patients with high CA153 were more likely to have bone metastases (p < 0.05), and those with high D-dimer were prone to lung metastasis (p < 0.05). With the increasing length of the postoperative period, the possibility of liver metastases gradually decreased, while that of chest wall recurrence gradually increased (p < 0.05).

Conclusion

Monitoring postoperative NLR, D-dimer, and CA153 is a convenient, practical method for diagnosing BC recurrence and metastasis. These metrics have good predictive value in terms of sites of recurrence and metastasis and the likelihood of multiple metastases.
An ingested metallic wire migrating from stomach to pancreas treated by laparoscopic surgery: A case report
Authors: Hao Fulong , Feng Qingbo , Li Jiaxin , Wu Hong
Published: January 2023

Introduction

Foreign bodies inside the pancreas are rare and usually occur after the ingestion of sharp objects such as a fish bone, a sewing needle, or a toothpick. Furthermore, an ingested metallic wire migrating from stomach to pancreas is very rare.

Case Presentation

We report a 36-year-old woman who was admitted to our hospital with “3-day history of dull progressive epigastric pain.” Computed tomography of the abdomen revealed a linear, high-density body between the stomach wall and the pancreas. During the operation, a linear, hard, metallic wire was found in the adhesive tissue between the gastric antrum and the pancreatic body. The operation was uneventful, and the patient recovered well.

Conclusion

The case of a foreign body inside the pancreas caused by a metallic wire is very rare. Radiological examinations play a vital role in the diagnosis of metallic wire ingestion. Metallic wire ingestion can be treated with laparoscopic surgery, both technically and safely.
An effective tool for predicting survival in breast cancer patients with de novo lung metastasis: Nomograms constructed based on SEER
Authors: Wang WenYi , Liu JiaJing , Chen YuQiu , Xu XiaoFan , Huo LiQun , Wang XuLin , Gu Jun
Published: January 2023

Background & objectives

An effective tool for forecasting the survival of BCLM is lacking. This study aims to construct nomograms to predict overall survival (OS) and breast cancer-specific survival (BCSS) in breast cancer patients with de novo lung metastasis, and to help clinicians develop appropriate treatment regimens for breast cancer lung metastasis (BCLM) individuals.

Methods

We gathered clinical data of 2,537 patients with BCLM between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Cox regression analysis was employed to identify independent prognostic parameters for BCLM, which were integrated to establish nomograms by R software. The discriminative ability and predictive accuracy of the nomograms were assessed using the concordance index (C-index), receiver operating characteristic (ROC) curves, and calibration plots. Kaplan–Meier analyses were applied to evaluate the clinical utility of the risk stratification system and investigate the survival benefit of primary site surgery, chemotherapy, and radiotherapy for BCLM patients.

Results

Two nomograms shared common prognostic indicators including age, marital status, race, laterality, grade, AJCC T stage, subtype, bone metastasis, brain metastasis, liver metastasis, surgery, and chemotherapy. The results of the C-index, ROC curves, and calibration curves demonstrated that the nomograms exhibited an outstanding performance in predicting the prognosis of BCLM patients. Significant differences in the Kaplan–Meier curves of various risk groups corroborated the nomograms' excellent stratification. Primary site surgery and chemotherapy remarkably improved OS and BCSS of BCLM patients whether the patients were at low-risk or high-risk, but radiotherapy did not.

Conclusions

We successfully developed prognostic stratification nomograms to forecast prognosis in BCLM patients, which provide important information for indicating prognosis and facilitating individualized treatment regimens for BCLM patients.
Carpal tunnel syndrome caused by tophi deposited under the epineurium of the median nerve: A case report
Authors: Zhang Wenzhong , Feng Qingbo , Gu Jiaxiang , Liu Hongjun
Published: January 2023

Introduction

Usually caused by compression of the wrist's median nerve, carpal tunnel syndrome (CTS) is one of the most common types of peripheral neuropathy. Tophi deposited under the epineurium of the median nerve compress the median nerve, leading to CTS, which is very rare.

Case presentation

We report a 64-year-old man with a history of tophaceous gout who presented with typical CTS symptoms and was admitted to our hospital. A physical examination revealed swelling over the right volar aspect of the carpal region, and he was unable to flex due to subcutaneous rigidity. Tinel's sign and Phalen's maneuver were positive. Electrophysiological studies confirmed the diagnosis of CTS. A carpal tunnel release and surgery to remove the gouty tophus of the right wrist were performed when serum uric acid levels were within normal limits (5.8 mg/dl). During the operation, tophi deposited under the epineurium of the median nerve were found, and the tophi were completely removed. Operative findings confirmed the diagnosis of CTS due to gout. The patient recovered uneventfully without signs of recurrence of gout and CTS symptoms during a 1-year follow-up period.

Conclusion

A gouty tophus is an uncommon cause of CTS, and CTS may be caused by gouty tophi if there is evidence of extrinsic compression of the median nerve or symptoms emanating from the carpal tunnel.
An improved method of searching inferior parathyroid gland for the patients with papillary thyroid carcinoma based on a retrospective study
Authors: Yan Shouyi , Lin Lanqin , Zhao Wenxin , Wang Bo , Zhang Liyong , Cai Shaojun
Published: January 2023

Objective

Many surgeons knew the importance of parathyroid gland (PG) in the thyroid surgery, but it was even more difficult to be protected. This study aimed at evaluating the effectiveness of the improved method of searching inferior parathyroid gland (IPG).

Methods

213 patients were enrolled and divided into test and control groups according to different methods of searching IPG in the surgery. Consequently, we compared the surgical outcome parameters between the two groups, including the operative time, numbers of PG identifying (PG protection in situ, PG auto-transplantation, and PG accidental removal), numbers of the total lymph node (LN) and metastatic LN, parathyroid hormone (PTH), transient hypoparathyroidism, transient recurrent laryngeal nerve palsy, and postoperative bleeding.

Results

We identified 194 (194/196, 98.98%) and 215 (215/230, 93.48%) PGs in the test group and control group, respectively, and there was a significant difference (P = 0.005), and this result was due to IPG identification differences (96/98, 97.96% vs. 100/115, 86.96%, P = 0.004). Meanwhile, there was a lower ratio of IPG auto-transplantation in the test group compared with that in the control group (46.94% vs. 64.35%, P = 0.013). Serum PTH one day after the operation was 3.65 ± 1.86 vs. 2.96 ± 1.64 (P = 0.043) but with no difference at 6 months. There were no differences in metastatic LN and recurrent laryngeal nerve palsy between two groups.

Conclusion

The improved method of searching IPG was simple, efficient, and safe, which was easy to be implemented for searching IPG and protecting it well.
Nonoperative treatment of avulsion fracture of the anterior tibia with proximal fibular fracture: A case report
Authors: Yu Jian , Zhang Chao , Wang Xu , Ma Xin , Huang Jiazhang
Published: January 2023

Background

Avulsion fracture of the anterior tibia with proximal fibular fracture commonly occurs in Maisonneuve fracture, which generally involves ankle instability and requires surgical correction. Nonoperative treatment of this type of fracture has been rarely reported in the literature.

Case presentation

A 48-year-old male reported pain in the lateral part of his left lower leg and ankle during a badminton play. Physical examination revealed tenderness and swelling of the lateral aspects of the left ankle, as well as the proximal aspect of the fibula. Preoperative plain x-ray image, computed tomography, and magnetic resonance imaging revealed an avulsion fracture of the anterior tibia by the anterior inferior tibiofibular ligament without medial and posterior fracture, rupture of the deltoid ligament, or interosseous membrane. Nonoperative management was performed and successful recovery was observed at a 6-month follow-up.

Conclusions

Nonoperative management can be a better option for some variations of Maisonneuve fracture with a stable ankle joint. The selection of treatment options should be based on careful examination and radiological evaluation of the ankle.
The top 100 most-cited articles on adult spinal deformity: The most popular topics are still sagittal plane parameters and complications
Authors: Liu Fu-Sheng , Deng Lin-Xia , Liu Fu-Bing , Zhang Qian-Shi , Wang Xiao-Bin , Li Jing
Published: January 2023

Purpose

This study aimed to summarize the characteristics of the 100 most-cited articles on adult spinal deformity (ASD) and to analyze past and current research hotspots and trends.

Methods

Literature searches (from inception to 28 April 2022) using Web of Science databases were conducted to identify ASD-related articles. The top 100 most-cited articles were collected for further analysis. Meanwhile, author keywords from articles published in the last 5 years were selected for further analysis.

Results

The top 100 most-cited articles on ASD were selected from 3,354 papers. The publication year ranged from 1979 to 2017, and all papers were written in English. The citation count among them ranged from 100 to 1,145, and the mean citation number was 215.2. The foremost productive first author was Schwab F. University of Washington had the largest number of publications. The United States of America had the largest number of published articles (n = 84) in this field. Spine was the most popular journal. Complications were the most studied themes. The visualization analysis of author keywords from the literature in the recent 5 years showed that complications, sagittal plane parameters, and surgical techniques are still the research hotspots, and minimally invasive surgery will continue to develop rapidly.

Conclusion

Based on a comparative analysis of the results of bibliometric and visualization, complications and sagittal plane parameters are still the major topics of research at present and even later, and minimally invasive surgery has a growth trend in this field of ASD.
Improved angle accuracy of tibial plateau osteotomy for total knee arthroplasty using tibial mechanical axis skin-mapping
Authors: He Peiheng , Huang Shuai , Liu Yong , Li Xing , Xu Dongliang
Published: January 2023

Background

The tibial crest is often used as an anatomic landmark for tibial plateau osteotomy (TPO) in total knee arthroplasty (TKA), but it is not very accurate. This study aimed to investigate errors in using the tibial crest as a marker and present a simple approach to improve the angle accuracy of TPO by mapping the tibial mechanical axis (TMA), determined preoperatively, according to the tibial crest on the skin overlying the tibia.

Methods

We evaluated 50 healthy young volunteers and 100 pre-TKA osteoarthritic knees. The middle tibial crest lines (MTCLs) were marked on the shank tibial skin and covered with Kirschner wires. All participants underwent two sets of anteroposterior (AP) standing radiographs of the lower extremity, with the feet in neutral and external rotation positions. The MTCL–TMA angles were measured and compared. The TMA was mapped onto the tibial skin according to the MTCL–TMA angle prior to TKA and used for TPO. Postoperative outcomes were determined by the angle between the vertical tibial component axis (TCA) and the TMA.

Results

The MTCL had no evident relationship with the TMA. A few MTCLs were parallel to the TMA. External rotation of the foot significantly changed the MTCL–TMA relationship. The angle accuracy of the TPO as guided by TMA skin-mapping was 0.83 ± 0.76°. No postoperative errors exceeded 3°.

Conclusion

The MTCL was not equivalent to the TMA. The TPO error can be reduced by preoperatively marking the TMA on the tibial skin according to the MTCL.
Establishment of prognostic models of adrenocortical carcinoma using machine learning and big data
Authors: Tang Jun , Fang Yu , Xu Zhe
Published: January 2023

Background

Adrenocortical carcinoma (ACC) is a rare malignant tumor with a short life expectancy. It is important to identify patients at high risk so that doctors can adopt more aggressive regimens to treat their condition. Machine learning has the advantage of processing complicated data. To date, there is no research that tries to use machine learning algorithms and big data to construct prognostic models for ACC patients.

Methods

Clinical data of patients with ACC were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. These records were screened according to preset inclusion and exclusion criteria. The remaining data were applied to univariate survival analysis to select meaningful outcome-related candidates. Backpropagation artificial neural network (BP-ANN), random forest (RF), support vector machine (SVM), and naive Bayes classifier (NBC) were chosen as alternative algorithms. The acquired cases were grouped into a training set and a test set at a ratio of 8:2, and a 10-fold cross-validation method repeated 10 times was performed. Area under the receiver operating characteristic (AUROC) curves were used as indices of efficiency.

Results

The calculated 1-, 3-, 5-, and 10-year overall survival rates were 62.3%, 42.0%, 34.9%, and 26.1%, respectively. A total of 825 patients were included in the study. In the training set, the AUCs of BP-ANN, RF, SVM, and NBC for predicting 1-year survival status were 0.921, 0.885, 0.865, and 0.854; those for predicting 3-year survival status were 0.859, 0.865, 0.837, and 0.831; and those for 5-year survival status were 0.888, 0.872, 0.852, and 0.841, respectively. In the test set, AUCs of these four models for 1-year survival status were 0.899, 0.875, 0.886, and 0.862; those for 3-year survival status were 0.871, 0.858, 0.853, and 0.869; and those for 5-year survival status were 0.841, 0.783, 0.836, and 0.867, respectively. The consequences of the 10-fold cross-validation method repeated 10 times indicated that the mean values of 1-, 3-, and 5-year AUROCs of BP-ANN were 0.890, 0.847, and 0.854, respectively, which were better than those of other classifiers (P < 0.008).

Conclusion

The model combined with BP-ANN and big data can precisely predict the survival status of ACC patients and has the potential for clinical application.
Novel end-to-side one-layer continuous pancreaticojejunostomy vs. end-to-end invaginated pancreaticojejunostomy in pancreatoduodenectomy: A single-center retrospective study
Authors: Luo Dong , Li Yixiong , Ji Liandong , Gong Xuejun
Published: January 2023

Background and Objective

Postoperative pancreatic fistula (POPF) is the most common critical complication after pancreatoduodenectomy (PD) and is the primary reason for increased mortality and morbidity after PD. We aim to investigate the clinical significance of a novel approach, i.e., end-to-side one-layer continuous pancreaticojejunostomy, for patients with PD.

Methods

The clinical data of 65 patients who underwent pancreatoduodenectomy at the Xiangya Hospital, Central South University, from September 2020 to December 2021 were retrospectively analyzed.

Results

Forty patients underwent end-to-end invaginated pancreaticojejunostomy, and 25 underwent the novel end-to-side one-layer continuous pancreaticojejunostomy. No significant differences were observed in pancreatic fistula, intraperitoneal infection, intraperitoneal bleeding, reoperation, postoperative hospital stay, or perioperative death between the two groups. However, the novel end-to-side one-layer continuous pancreaticojejunostomy group had significantly shorter operation duration (32.6 ± 5.1 min vs. 8.3 ± 2.2 min, p < 0.001). The incidence of pancreatic fistula in the novel pancreaticojejunostomy group was 12%, including two cases of grade A POPF and only one case of grade B POPF. No cases of grade C POPF occurred. No deaths were observed during the perioperative period.

Conclusions

The novel anastomosis method leads to a shorter operation duration than the traditional anastomosis method and does not increase postoperative complications. In conclusion, it is a simplified and feasible method for pancreatic anastomosis.
Study of the short-term quality of life of patients with esophageal cancer after inflatable videoassisted mediastinoscopic transhiatal esophagectomy
Authors: Wang Gaoxiang , Sun Xiaohui , Li Tian , Xu Meiqing , Guo Mingfa , Liu Changqing , Xie Mingran
Published: January 2023

Objective

To compare the short-term outcomes and postoperative quality of life in patients with esophageal cancer between inflatable videoasisted mediastinoscopic transhiatal esophagectomy (IVMTE) and minimally invasive Mckeown esophagectomy (MIME), and to evaluate the value of IVMTE in the surgical treatment of esophageal cancer.

Methods

A prospective, nonrandomized study was adopted. A total of 60 esophageal cancer patients after IVMTE and MIME December 2019 to January 2022 were included. Among them, 30 patients underwent IVMTE and 30 patients underwent MIME. Shortterm outcomes (including the operation time, intraoperative blood loss, postoperative drainage 3 days, total postoperative tube time, postoperative hospital stay, number and number of thoracic lymph node dissection stations, postoperative complications and so on), postoperative quality of life, [including Quality of Life Core Questionnaire (QLQ-C30) and the esophageal site-specific module (QLQ-OES18)] were compared between the 2 groups.

Results

The operation time, intraoperative blood loss, postoperative drainage volume and total postoperative intubation time in IVMTE group were significantly lower than those in MIME group (P < 0.05). A total of 22 patients had postoperative complications, including 7 patients in IVMTE group (23.3%) and 15 patients in MIME group (50.0%). There was significant difference between the two groups (P = 0.032). The physical function, role function, cognitive function, emotional function and social function and the overall health status in the IVMTE group were higher than those in the MIME group at all time points after operation, while the areas of fatigue, nausea, vomiting and pain symptoms in the MIME group were lower than those in the MIME group at all time points after operation.

Conclusion

IVMTE is a feasible and safe alternative to MIME. Therefore, when the case is appropriate, IVMTE should be given priority, which is conducive to postoperative recovery and improve the quality of life of patients after operation.
Application of 3D printed patient-specific instruments in the treatment of large tibial bone defects by the Ilizarov technique of distraction osteogenesis
Authors: Zheng Hao , Wang Lili , Jiang Wenbo , Qin Ruiqing , Zhang Zhiyu , Jia Zhuqing , Zhang Jian , Liu Yong , Gao Xuejian
Published: January 2023

Background

The Ilizarov technique of distraction osteogenesis is an effective treatment for tibia defect. However, repeated attempts to reduce due to the complexity of the bone defect during the operation will increase the operation time and iatrogenic injury, and excessive radiation exposure. Three-dimensional (3D)-printed patient-specific instrument (PSI) for preoperative 3D planning and intraoperative navigation have the advantages of accuracy and visualization. The purpose of this study is to investigate whether 3D-printed PSI is helpful to correct tibial bone defects accurately and effectively.

Method

From May 2019 to September 2022, 19 patients with tibial bone defects were treated, including 9 males and 10 females, aged 37 to 64 years. There were 4 cases in proximal tibia, 9 in midshaft tibia and 6 in distal tibia. All were treated with Ilizarov technique of distraction osteogenesis. 3D-printed PSI was used in 9 cases, while traditional surgery was used in 10 cases. All patients underwent computed tomography before surgery. Computer software was used to analyze the measurement results, design and print PSI. During the operation, PSI was used to assist in reduction of tibia. Operation times were recorded in all cases, the number of fluoroscopy during the operation, and the varus/valgus, anteversion/reversion angle after the operation were measured. All measurement data were expressed by means ± SD, and Student's t test was used to examine differences between groups. The chi square test or Fisher's precise test was used to compare the counting data of the two groups.

Result

All PSI matched well with the corresponding tibia bone defect, and were consistent with the preoperative plan and intraoperative operation. The affected limb had a good reduction effect. The operation time from the beginning of PSI installation to the completion of Ilizarov ring fixator installation was 31.33 ± 3.20 min, while that in the traditional operation group was 64.10 ± 6.14 min (p < 0.001). The times of fluoroscopy in the PSI group during operation was 10.11 ± 1.83, and that in the traditional operation group was 27.60 ± 5.82. The reduction effect of tibia in PSI group was better than that in traditional operation group, with the average angle of PSI group is 1.21 ± 0.24°, and that of traditional operation group is 2.36 ± 0.33° (p < 0.001).

Conclusion

The PSI simplifies procedures, reduces the difficulty of the operation, improves the accuracy of the operation, and provides a good initial position when used in distraction osteogenesis to treat the tibial defects.
Preoperative prediction of early recurrence of HBV-related hepatocellular carcinoma (≤5 cm) by visceral adipose tissue index
Authors: Wu Zong-qian , Cheng Jie , Xiao Xi-xi , Zhang Hua-rong , Wang Jian , Peng Juan , Liu Chen , Cai Ping , Li Xiao-ming
Published: January 2023

Background

This study aimed to investigate whether visceral adipose tissue index (VATI) is a significant risk factor for the early recurrence (ER) of HBV-related hepatocellular carcinoma (HCC) (≤5 cm) after hepatectomy.

Methods

The recruited cohort patients who were positive for hepatitis B virus, presented with surgically confirmed HCC (≤5 cm) from Army Medical University (internal training cohort: n = 192) and Chongqing Medical University (external validation group: n = 46). We measured VATI, subcutaneous adipose tissue index (SATI) via computed tomography (CT). ER was defined as recurrence within 2 years after hepatectomy. The impact of parameters on outcome after hepatectomy for HCC was analyzed.

Results

Univariate analysis showed that alpha-fetoprotein levels (p = 0.044), body mass index (BMI) (p < 0.001), SATI (p < 0.001), and VATI (p < 0.001) were significantly different between ER and non-ER groups in internal training cohort. Multivariate analysis identified VATI as an independent risk factor for ER (odds ratio = 1.07, 95% confidence interval: 1.047–1.094, p < 0.001), with a AUC of 0.802, based on the cut-off value of VATI, which was divided into high risk (≥37.45 cm2/m2) and low risk (<37.45 cm2/m2) groups. The prognosis of low risk group was significantly higher than that of high risk group (p < 0.001). The AUC value of VATI in external validation group was 0.854.

Conclusion

VATI was an independent risk factor for the ER, and higher VATI was closely related to poor outcomes after hepatectomy for HBV-related HCC (≤5 cm).
Staged open reduction and internal fixation with double-locking plates to treat bilateral distal femur periprosthetic fractures after total knee arthroplasty: A case report
Authors: Wu Jiangpeng , Li Zheng , Huang Jiang , Jiao Xufeng , Cao Guanglei
Published: January 2023

Background

The incidence of periprosthetic fractures after total knee arthroplasty (TKA) increases in parallel with the number of procedures. Comminuted fractures along the primary fracture line extending to the edge of the prosthesis are challenging, and bilateral fractures are rarely reported, especially with open injuries.

Case presentation

A 65-year-old female had undergone bilateral TKA in our hospital 5 years before admission. She was admitted with a traumatic bilateral Rorabeck type II B distal femur periprosthetic fracture (closed right, open left, Gustilo II) and was treated with bilateral staged open reduction and internal fixation (ORIF) with double-locking plates. The patient experienced a prolonged delayed fracture union and finally healed around 21 months postoperatively. The function was satisfactory after 4 years of follow-up.

Conclusion

ORIF with double-locking plates can be used to treat Rorabeck II B periprosthetic fracture where the primary fracture line extends beyond the edge of the prosthesis; however, there may be delayed healing or nonunion. Patients need to undergo long-term rehabilitation and endure long disability times and require good rehabilitation nursing care. Once they achieve bone healing, the treatment achieves bone preservation and substantial prosthesis survival.