BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE...BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE SUMMARY A 39-year-old woman presented with a growing solitary pulmonary nodule measuring 2.0 cm in the right upper lobe(RUL)of the lung.The patient underwent a RUL anterior segmentectomy using uniportal video-assisted thoracoscopy.A preliminary tissue diagnosis indicated malignancy;however,it was later revised to an IMTs.Due to the absence of a minor fissure between the right upper and middle lobes,an alternative resection approach was necessary.Therefore,we utilized indocyanine green injection to aid in delineating the intersegmental plane.Following an uneventful recovery,the patient was discharged on the third postoperative day.Thereafter,annual chest tomography scans were scheduled to monitor for potential local recurrence.CONCLUSION This case underscores the challenges in diagnosing and managing IMTs,showing the importance of accurate pathologic assessments and tailored surgical strategies.展开更多
BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with ...BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.展开更多
Symptomatic cyclops lesions are complications that can be seen at rates of up to approximately 10%after anterior cruciate ligament reconstruction.However,recurrent cyclops lesions have rarely been documented.There are...Symptomatic cyclops lesions are complications that can be seen at rates of up to approximately 10%after anterior cruciate ligament reconstruction.However,recurrent cyclops lesions have rarely been documented.There are case rare series in the literature regarding the treatment of recurrent cyclops lesion.Future large studies are needed to investigate factors contributing to the development of cyclops lesions and syndrome and treatment options.展开更多
BACKGROUND Total knee arthroplasty(TKA)is a mature procedure recommended for correcting knee osteoarthritis deformity,relieving pain,and restoring normal biomechanics.Although TKA is a successful and cost-effective pr...BACKGROUND Total knee arthroplasty(TKA)is a mature procedure recommended for correcting knee osteoarthritis deformity,relieving pain,and restoring normal biomechanics.Although TKA is a successful and cost-effective procedure,patient dissatisfaction is as high as 50%.Knee pain after TKA is a significant cause of patient dissatisfaction;the most common location for residual pain is the anterior region.Between 4%and 40%of patients have anterior knee pain(AKP).AIM To investigate the effect of various TKA procedures on postoperative AKP.METHODS We searched PubMed,EMBASE,and Cochrane from January 2000 to September 2022.Randomized controlled trials with one intervention in the experimental group and no corresponding intervention(or other interventions)in the control group were collected.Two researchers independently read the title and abstract of the studies,preliminarily screened the articles,and read the full text in detail according to the selection criteria.Conflicts were resolved by consultation with a third researcher.And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software.RESULTS There were 25 randomized controlled trials;13 were comparative studies with or without patellar resurfacing.The meta-analysis showed no significant difference between the experimental and control groups(P=0.61).Six studies were comparative studies of circumpatellar denervation vs non-denervation,divided into three subgroups for meta-analysis.The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups(P=0.31,P=0.50).One subgroup meta-analysis showed a significant difference between the experimental and control groups(P=0.001).Two studies compared fixed-bearing TKA and mobile-bearing TKA;the results meta-analysis showed no significant difference between the experimental and control groups(P=0.630).Two studies compared lateral retinacular release vs non-release;the meta-analysis showed a significant difference between the experimental and control groups(P=0.002);two other studies compared other factors.CONCLUSION Patellar resurfacing,mobile-bearing TKA,and fixed-bearing TKA do not reduce the incidence of AKP.Lateral retinacular release can reduce AKP;however,whether circumpatellar denervation can reduce AKP is controversial.展开更多
BACKGROUND Over 90%of rectal cancer patients develop low anterior resection syndrome(LARS)after sphincter-preserving resection.The current globally recognized evaluation method has many drawbacks and its subjectivity ...BACKGROUND Over 90%of rectal cancer patients develop low anterior resection syndrome(LARS)after sphincter-preserving resection.The current globally recognized evaluation method has many drawbacks and its subjectivity is too strong,which hinders the research and treatment of LARS.AIM To evaluate the anorectal function after colorectal cancer surgery by quantifying the index of magnetic resonance imaging(MRI)defecography,and pathogenesis of LARS.METHODS We evaluated 34 patients using the standard LARS score,and a new LARS evaluation index was established using the dynamic images of MRI defecography to verify the LARS score.RESULTS In the LARS score model,there were 10(29.41%)mild and 24(70.58%)severe cases of LARS.The comparison of defecation rate between the two groups was 29.36±14.17%versus 46.83±18.62%(P=0.004);and MRI-rectal compliance(MRI-RC)score was 3.63±1.96 versus 7.0±3.21(P=0.001).Severe and mild LARS had significant differences using the two evaluation methods.There was a significant negative correlation between LARS and MRI-RC score(P<0.001),and they had a negative correlation with defecation rate(P=0.028).CONCLUSION MRI defecography and standard LARS score can both be used as an evaluation index to study the pathogenesis of LARS.展开更多
Stroke is a physiological alteration associated with changes in blood flow that can result in sudden-onset cognitive impairment. It has a heterogenous clinical presentation with varying degrees of severity correlated ...Stroke is a physiological alteration associated with changes in blood flow that can result in sudden-onset cognitive impairment. It has a heterogenous clinical presentation with varying degrees of severity correlated with specific central nervous system zones or areas, and its prognosis is uncertain. This case study describes a 62-year-old male patient with acquired brain damage of the anterior cingulate cortex as a result of an ischemic event in the territory of the left anterior cerebral artery. Cognitive function was assessed using the neuropsychological executive function and frontal lobe test battery (BANFE-2) as well as other neuropsychological tests. The results show a profile of higher mental functions characterized by the presence of dysexecutive syndrome with marked behavioral alteration and diencephalic amnesia. .展开更多
Objective:To observe the clinical effect of articular cavity injection combined with bite splint therapy for the treatment of anterior disc displacement without reduction(ADDWoR).Methods:The research subjects for this...Objective:To observe the clinical effect of articular cavity injection combined with bite splint therapy for the treatment of anterior disc displacement without reduction(ADDWoR).Methods:The research subjects for this study were 30 patients with ADDWoR treated in the temporomandibular joint specialist outpatient clinic from November 2018 to November 2019,with a disease duration of 1 to 6 months.The treatment group was treated with an articular cavity injection of sodium hyaluronate+bite splint.The control group was treated with a simple articular cavity injection of sodium hyaluronate.The two groups were followed up once every 2 weeks to evaluate the treatment effect and observe the clinical efficacy of the two groups.Statistical analysis was carried out using SPSS 24.0.t-test and general linear regression analysis were carried out to compare the data of both groups,andχ^(2)-test and binary logistic regression analysis were performed for pain index comparison.Results:There was no significant difference in terms of the efficacy of the treatment received by both groups.The mouth opening and joint pain of patients in both groups were significantly improved after treatment(P<0.001).Conclusion:Articular cavity injection of sodium hyaluronate and occlusal splint therapy are both effective and safe methods for treating ADDWoR.展开更多
Anterior cruciate ligament(ACL)injury is one of the most common types of sports injuries.People’s need to participate in sports and desire for a high quality of life promotes the continuous development of ACL reconst...Anterior cruciate ligament(ACL)injury is one of the most common types of sports injuries.People’s need to participate in sports and desire for a high quality of life promotes the continuous development of ACL reconstruction technology.Arthroscopic ACL reconstruction has been recognized as an effective method for the treatment of ACL injuries.This review analyses and summarizes the advantages and limitations of each surgical procedure for arthroscopic ACL reconstruction reported in the relevant literature so as to promote the future development of more relevant techniques.展开更多
BACKGROUND Cyclops lesions are a known complication of anterior cruciate ligament(ACL)reconstruction,with symptomatic cyclops syndrome occurring in up to 11%of surgeries.Recurrent cyclops lesions have been rarely docu...BACKGROUND Cyclops lesions are a known complication of anterior cruciate ligament(ACL)reconstruction,with symptomatic cyclops syndrome occurring in up to 11%of surgeries.Recurrent cyclops lesions have been rarely documented;this case study documents the successful treatment of a recurrent cyclops lesion.CASE SUMMARY A 28-year-old female presented following a non-contact injury to the right knee.Workup and clinical exam revealed an ACL tear,and arthroscopic reconstruction was performed.Two years later a cyclops lesion was discovered and removed via arthroscopic synovectomy.Seven months postoperatively,the patient presented with pain,stiffness,and difficulty achieving terminal extension.A smaller recurrent cyclops lesion was diagnosed,and a repeat synovectomy was performed.The patient recovered fully.CONCLUSION To the best of our knowledge,this is the first documented case of recurrent cyclops lesion after bone-patellar tendon-bone allograft ACL reconstruction presenting as cyclops syndrome.展开更多
AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK)....AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK).METHODS:In this noncomparative,retrospective case series,10 subjects(6 males,4 females)with a mean age of 56.5±7.1(range 47-72)y with high-risk FK undergone the two-step strategy were included.Reported outcome measures were healing of the corneal ulcer,recurrence of FK,reject reaction,improvement in best corrected visual acuity(BCVA)and relevant complications.RESULTS:The average diameter of corneal infiltrates was 7.50±0.39 mm,ranging from 6.94 to 8.13 mm.The mean depth of corneal infiltrates was 422.4±77.1μm,ranging from 350 to 535μm.The mean corneal thickness was 597.4±117.3μm,ranging from 458 to 851μm.Hypopyon and endothelial plaques were presented in all patients.The period between the two steps was 3.65±0.9(ranging from 3 to 5)mo.The graft diameter was 7.75±0.39 mm.At the last follow-up(average 9.25±3.39,ranging from 5.5 to 17mo),no fungal recurrence or graft rejection appeared,and all patients showed improvement of BCVA.One patient suffered from liver function impairment due to oral voriconazole for 4wk and recovered spontaneously after 1wk of drug withdrawal.CONCLUSION:The two-step strategy is safe and effective in the treatment of high-risk FK by transforming intentional therapeutic penetrating keratoplasty during acute infection to later optical DALK.It is a practical strategy,especially in areas lacking fresh donor corneas and eye bank services.展开更多
BACKGROUND Many studies have focused on the femoral tunnel technique and fixation method,but few studies have involved the tibial tunnel technique and fixation method.The all-inside technique is one of the new techniq...BACKGROUND Many studies have focused on the femoral tunnel technique and fixation method,but few studies have involved the tibial tunnel technique and fixation method.The all-inside technique is one of the new techniques that has been described in recent years.All-inside anterior cruciate ligament(ACL)reconstruction is based on a tibial socket instead of a full tunnel.This method has many potential advantages.AIM To compare clinical outcomes of knee ACL autograft reconstruction using allinside quadrupled semitendinosus(AIST)and traditional hamstring tendon(TBT)techniques.METHODS From January 2017 to October 2019,the clinical data of 80 patients with ACL reconstruction were retrospectively analyzed,including 67 males and 13 females.The patients had an average age of 24.3±3.1 years(age range:18-33 years).The AIST technique was used in 42 patients and the TBT technique was used in 38 patients.The time between operation and injury,operative duration,postoperative visual analogue scale(VAS)score and knee functional recovery were recorded and compared between the two groups.The International Knee Documentation Committee(IKDC)and Lysholm scoring system were used to comprehensively evaluate clinical efficacy.RESULTS Eighty patients were followed for 24-36 mo,with an average follow-up duration of 27.5±1.8 mo.There were no significant differences in the time between surgery and injury,operative duration,IKDC and Lysholm scores of the affected knee at the last follow-up evaluation between the two groups.There were significant differences in VAS scores 1 d,3 d,7 d,2 wk and 1 mo after surgery(P<0.05).There was no significant difference in VAS score at 3 mo,6 mo and 1 year after operation.CONCLUSION The efficacy of the AIST ACL reconstruction technique was comparable to the TBT technique,but the postoperative pain was less with the AIST technique.Thus,the AIST technique is an ideal treatment choice for ACL reconstruction.展开更多
AIM:To compare anterior segment parameters between two groups of type 2 diabetic with and without diabetic retinopathy(DR)and non-diabetic elderly subjects based on hemoglobin A1c(Hb A1c)levels and status of DR.METHOD...AIM:To compare anterior segment parameters between two groups of type 2 diabetic with and without diabetic retinopathy(DR)and non-diabetic elderly subjects based on hemoglobin A1c(Hb A1c)levels and status of DR.METHODS:This study was conducted on 997 residents aged 60y or over in Tehran,Iran.Diabetic group had Hb A1c level≥6.4%with no other systemic problems.The non-diabetic participants had normal eye findings and no systemic diseases.K1,K2,mean K,Q-value,anterior,central,posterior,and total corneal densitometric findings,anterior chamber volume(ACV),anterior chamber depth(ACD),corneal volume(CV),and pachymetry were measured by Pentacam AXL.RESULTS:A total of 678 non-diabetic(39%male)and 319 diabetic(35%male)subjects with mean age of 66.31±5.23 and 67.22±4.96y were examined,respectively.No statistically significant difference was found in anterior segment parameters between non-diabetic and diabetic groups(all P>0.05).However,middle,posterior,and total corneal densitometric values were statistically different between two groups af ter controlling the ef fects of confounders(P=0.014,0.007,and 0.042,respectively).Corneal densitometric values in all layers,ACD,and ACV were different between diabetic subjects with and without DR(all P<0.05).In the diabetic group,only corneal densitometric values had a negative relationship with fasting blood sugar(P<0.001).ACD and ACV had a negative correlation with Hb A1c levels(all P<0.05,r=-0.129 and-0.146,respectively).However,the relationships were not observed after controlling the confounders(P=0.938,0.466,respectively).CONCLUSION:Considering the higher densitometric values of the cornea and lower ACD and ACV in diabetic subjects with DR,it is suggested that the examiners should perform comprehensive retinal examinations when faced with such conditions.展开更多
Objective:To describe the outcome of female anterior wall(pubic side)onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive tec...Objective:To describe the outcome of female anterior wall(pubic side)onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques.Methods:From January 2016 to April 2018,17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study.The diagnosis of urethral stricture was confirmed based on a combination of patients’symptoms,post-void residual urine,video-urodynamics,and cystoscopy.Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection.Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score,post-void residual urine,and maximum flow rate.Results:Despite the previously failed minimally invasive procedures,urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes(success rateZ94%).The meanstandard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up(25.823.97 to 10.885.57);so did postvoid residual urine(71.1274.98 mL to 15.0028.30 mL),and maximum flow rate(7.881.72 mL/s to 25.825.59 mL/s)with all statistically significant(p<0.05).Conclusion:The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands.An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate.A laterally extended incision may improve visualization and better graft placement by providing wider working space.The results should be evaluated in the future studies with larger sample size.展开更多
BACKGROUND Low anterior resection syndrome(LARS)severely impairs patient postoperative quality of life,especially major LARS.However,there are few tools that can accurately predict major LARS in clinical practice.AIM ...BACKGROUND Low anterior resection syndrome(LARS)severely impairs patient postoperative quality of life,especially major LARS.However,there are few tools that can accurately predict major LARS in clinical practice.AIM To develop a machine learning model using preoperative and intraoperative factors for predicting major LARS following laparoscopic surgery of rectal cancer in Chinese populations.METHODS Clinical data and follow-up information of patients who received laparoscopic anterior resection for rectal cancer from two medical centers(one discovery cohort and one external validation cohort)were included in this retrospective study.For the discovery cohort,the machine learning prediction algorithms were developed and internally validated.In the external validation cohort,we evaluated the trained model using various performance metrics.Further,the clinical utility of the model was tested by decision curve analysis.RESULTS Overall,1651 patients were included in the present study.Anastomotic height,neoadjuvant therapy,diverting stoma,body mass index,clinical stage,specimen length,tumor size,and age were the risk factors associated with major LARS.They were used to construct the machine learning model to predict major LARS.The trained random forest(RF)model performed with an area under the curve of 0.852 and a sensitivity of 0.795(95%CI:0.681-0.877),a specificity of 0.758(95%CI:0.671-0.828),and Brier score of 0.166 in the external validation set.Compared to the previous preoperative LARS score model,the current model exhibited superior predictive performance in predicting major LARS in our cohort(accuracy of 0.772 for the RF model vs 0.355 for the preoperative LARS score model).CONCLUSION We developed and validated a robust tool for predicting major LARS.This model could potentially be used in the clinic to identify patients with a high risk of developing major LARS and then improve the quality of life.展开更多
Injury to the anterior talofibular ligament(ATFL)is a common acute injury of the lateral foot ligament.Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients....Injury to the anterior talofibular ligament(ATFL)is a common acute injury of the lateral foot ligament.Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients.The purpose of this paper is to review the anatomy and the current methods of diagnosis and treatment of acute injury to the ATFL.The clinical manifestations of acute injury to the ATFL include pain,swelling,and dysfunction.At present,non-surgical treatment is the first choice for acute injury of the ATFL.The standard treatment strategy involves the“peace and love”principle.After initial treatment in the acute phase,personalized rehabilitation training programs can be followed.These may involve proprioception training,muscle training,and functional exercise to restore limb coordination and muscle strength.Static stretching and other techniques to loosen joints,acupuncture,moxibustion massage,and other traditional medical treatments can relieve pain,restore range of motion,and prevent joint stiffness.If the non-surgical treatment is not ideal or fails,surgical treatment is feasible.Currently,arthroscopic anatomical repair or anatomical reconstruction surgery is commonly used in clinical practice.Although open Broström surgery provides good results,the modified arthroscopic Broström surgery has many advantages,such as less trauma,rapid pain relief,rapid postoperative recovery,and fewer complications,and is more popular with patients.In general,when treating acute injury to the ATFL,treatment management and methods should be timely and reasonably arranged according to the specific injury scenario and attention should be paid to the timely combination of multiple therapies to achieve the best treatment results.展开更多
AIM:To determine the normative distribution of axial length(AL),anterior chamber depth(ACD),anterior chamber volume(ACV),anterior chamber angle(ACA),and some of their associated factors in subjects aged 60 and over.ME...AIM:To determine the normative distribution of axial length(AL),anterior chamber depth(ACD),anterior chamber volume(ACV),anterior chamber angle(ACA),and some of their associated factors in subjects aged 60 and over.METHODS:In this cross-sectional study,160 clusters were sampled using multi-stage cluster sampling in Tehran,Iran.After a preliminary interview,the participants underwent optometric examinations including visual acuity and refraction measurement followed by slit lamp biomicroscopy.Finally,ocular imaging was done using the Pentacam AXL to measure AL,ACD,ACV,and ACA.RESULTS:A total of 4519 eyes of 2436 participants were evaluated,of whom 58.0%(n=1412)were female.The mean age of the subjects was 67.32±6.05y(range:60-95y).The mean AL,ACD,ACV,and ACA was 23.22 mm(23.18-23.27 mm),2.61 mm(2.59-2.62 mm),126.56 mm3(125.08-128.04 mm3),and 30.61°(30.3°-30.92°),respectively.In the multivariable model,after adjusting for the effect of both eyes,the longest and shortest AL was seen in myopic and hyperopic subjects,respectively.AL,ACD,ACV and ACA were significantly larger in men compared to women(P<0.001).Except ACA,other evaluated parameters showed an inverse correlation with age(P<0.001),however,this correlation was insignificant for AL(P=0.623).CONCLUSION:Normative value of AL,and other biometric parameters are specific for each ethnicity,age and sex group.Any alteration in these parameters and their effect on refraction should be considered in this age group,especially in case of cataract surgery.展开更多
BACKGROUND Anterior cruciate ligament(ACL)tears are common sports-related injuries.Their incidence is not the same either for all the sports or for the same sport across various nations.This information is maintained ...BACKGROUND Anterior cruciate ligament(ACL)tears are common sports-related injuries.Their incidence is not the same either for all the sports or for the same sport across various nations.This information is maintained by many sports leagues in their registries.However,very few nationwide registries exist for such injuries.This study is carried out to know the demographic characteristics of patients who underwent ACL reconstruction at our hospital in India.AIM To know the demographic characteristics of patients who underwent ACL reconstruction at a tertiary care hospital in India.METHODS All the patients who underwent ACL reconstruction from January 2020 to December 2021 were retrospectively studied.Patients with multi-ligament injuries or a history of previous knee surgery were excluded.The patients’history was obtained from the hospital records,they were interviewed telephonically,and online questionnaires were given.Their demographic data was analyzed and compared to the existing literature.RESULTS A total of 124 patients were operated on for ACL reconstruction during this period.The mean age of the patients was 27.97 years.One hundred and thirteen patients(91.1%)were male and 11(8.9%)were female.The majority of the patients(47.6%)sustained this injury by road traffic accidents(RTA)followed by sportsrelated injuries(39.5%).The commonest presenting complaint was giving way of the knee in 118 patients(95.2%).The mean duration from the injury to the first hospital visit among the patients was 290.1 d.The mean duration from the injury to surgery was 421.8 d.CONCLUSION ACL patients’demography is different in developing nations as compared to the developed world.RTA are the leading cause of ACL injuries and are followed by recreational sports as a cause.There is delayed access to healthcare leading to delayed diagnosis as well as even greater time to surgery.This,in turn,leads to poorer prognosis and longer rehabilitation.National registries for developing nations are the need of the hour due to the different demographics of ACL injuries in developing countries.展开更多
Objective This study aimed to compare the postoperative analgesia and recovery of ultrasound-guided erector spinae plane block combined with serratus anterior plane block(ESPB combined with SAPB)versus thoracic parave...Objective This study aimed to compare the postoperative analgesia and recovery of ultrasound-guided erector spinae plane block combined with serratus anterior plane block(ESPB combined with SAPB)versus thoracic paravertebral block(PVB)after thoracoscopic surgery.Methods Ninety-two patients who underwent video-assisted thoracoscopic surgery(VATS)were randomly divided into group S(n=46)and group P(n=46).After anesthesia induction,the same anesthesiologist performed ultrasound-guided ESPB at T5 and T7 levels combined with SAPB at the level of the fifth rib in the midaxillary line in group S and ultrasound-guided PVB at T5 and T7 levels in group P.Patients in both groups were given 40 mL of 0.4%ropivacaine.Eighty-six patients completed the study(group S,n=44;group P,n=42).The morphine consumption,visual analogue scale(VAS)scores at rest and coughing,and frequency of remedial analgesia were recorded at 1,2,4,8,and 24 h postoperatively.Pulmonary function parameters were recorded at 1,4,and 24 h postoperatively,and the quality of recovery(QoR)-15 score at 24 h postoperatively.The adverse effects,duration of chest tube drainage and length of stay were also recorded.Results The morphine consumption at postoperative 4 and 8 h and the incidence of ipsilateral shoulder pain(ISP)were significantly lower in group S than in group P.The QoR-15 questionnaire score at postoperative 24 h was significantly lower in group P than in group S(P<0.05).The morphine consumption was lower at 24 h postoperatively in group S than in group P,with no significant difference found yet.The morphine consumption at other observed times,VAS scores,pulmonary function parameters,frequency of remedial analgesia,duration of chest tube drainage,length of stay,and incidence of other adverse events were comparable between group S and group P.Conclusion Ultrasound-guided ESPB combined with SAPB is non-inferior to PVB in terms of morphine consumption at postoperative 24 h and postoperative recovery.But,this approach can significantly reduce morphine consumption in the early postoperative period(0–8 h)after thoracoscopy with lower incidence of ISP.It is a simpler and safer operation.展开更多
BACKGROUND Inferior oblique anterior transposition(IOAT)has emerged as an effective surgery in the management of dissociated vertical deviation(DVD)combined with superior oblique palsy(SOP).Traditional IOAT usually pr...BACKGROUND Inferior oblique anterior transposition(IOAT)has emerged as an effective surgery in the management of dissociated vertical deviation(DVD)combined with superior oblique palsy(SOP).Traditional IOAT usually provides satisfactory primary position alignment and simultaneously restricts the superior floating phenomenon.However,it also increases the risk of the anti-elevation syndrome and narrowing of the palpebral fissure in straight-ahead gaze,especially after the unilateral operation.CASE SUMMARY We report the outcomes of the modified unilateral IOAT in two patients with unilateral DVD combined with SOP.The anterior-nasal fibers of the inferior oblique muscle were attached at 9 mm posterior to the corneal limbus along the temporal board of the inferior rectus muscle,the other fibers were attached a further 5 mm temporal to the anterior-nasal fibers.Postoperatively,both hypertropia and floating were improved,and no obvious complications occurred.CONCLUSION In these cases,the modified unilateral IOAT was an effective and safe surgical method for treating DVD with SOP.展开更多
AIM:To describe the outcome of using low-dose laser cycloplasty(LCP)in chronic angle-closure glaucoma(CACG).METHODS:A retrospective case series.Medical charts of CACG patients who underwent LCP in the Eye Hospital of ...AIM:To describe the outcome of using low-dose laser cycloplasty(LCP)in chronic angle-closure glaucoma(CACG).METHODS:A retrospective case series.Medical charts of CACG patients who underwent LCP in the Eye Hospital of Wenzhou Medical University were reviewed.The main outcomes included intraocular pressure(IOP),the number of glaucoma medication,anterior segment parameters and surgery-related complications.RESULTS:A total of 7 eyes of 7 CACG patients(age 38.9±11.0y)underwent LCP with a mean follow-up of 27.1±13.7mo(range 16-48mo).Following LCP,mean IOP and glaucoma medications decreased from 26.1±6.1 mm Hg with 3.1±1.1 glaucoma medications pre-treatment to 14.9±3.1 mm Hg(P=0.027)with 0.4±1.1 glaucoma medications(P=0.001)at final follow-up.The anterior chamber depth(ACD),angle opening distance500 and trabecular-iris angle increased from 1.65±0.33 mm,0.05 mm(range 0-0.30 mm)and 5.1°(range,0-31.97°)at baseline to 1.98±0.43 mm(P=0.073),0.53 mm(range 0.42-0.91 mm,P=0.015),45.9°(range,40.2°-59.4°),(P=0.015)in the long-term follow-up,respectively.The deepening of ACD and reopening of anterior chamber angle(ACA)was observed in 6 eyes(85.7%).CONCLUSION:LCP is a promising treatment option for patients with CACG via reducing IOP and glaucoma medication without serious complications.In addition,LCP can bring a significant deepening in ACD and reopening of ACA.展开更多
文摘BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE SUMMARY A 39-year-old woman presented with a growing solitary pulmonary nodule measuring 2.0 cm in the right upper lobe(RUL)of the lung.The patient underwent a RUL anterior segmentectomy using uniportal video-assisted thoracoscopy.A preliminary tissue diagnosis indicated malignancy;however,it was later revised to an IMTs.Due to the absence of a minor fissure between the right upper and middle lobes,an alternative resection approach was necessary.Therefore,we utilized indocyanine green injection to aid in delineating the intersegmental plane.Following an uneventful recovery,the patient was discharged on the third postoperative day.Thereafter,annual chest tomography scans were scheduled to monitor for potential local recurrence.CONCLUSION This case underscores the challenges in diagnosing and managing IMTs,showing the importance of accurate pathologic assessments and tailored surgical strategies.
基金This study was reviewed and approved by the Ethics Committee of the HUB-Hospital Erasme.
文摘BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.
文摘Symptomatic cyclops lesions are complications that can be seen at rates of up to approximately 10%after anterior cruciate ligament reconstruction.However,recurrent cyclops lesions have rarely been documented.There are case rare series in the literature regarding the treatment of recurrent cyclops lesion.Future large studies are needed to investigate factors contributing to the development of cyclops lesions and syndrome and treatment options.
基金Supported by the Capital Fund Project for Clinical Diagnosis and Treatment Technology Research and Translational Application,No.Z201100005520091and Beijing Traditional Chinese Medicine Science and Technology Development Fund Project,No.JJ-2020-67.
文摘BACKGROUND Total knee arthroplasty(TKA)is a mature procedure recommended for correcting knee osteoarthritis deformity,relieving pain,and restoring normal biomechanics.Although TKA is a successful and cost-effective procedure,patient dissatisfaction is as high as 50%.Knee pain after TKA is a significant cause of patient dissatisfaction;the most common location for residual pain is the anterior region.Between 4%and 40%of patients have anterior knee pain(AKP).AIM To investigate the effect of various TKA procedures on postoperative AKP.METHODS We searched PubMed,EMBASE,and Cochrane from January 2000 to September 2022.Randomized controlled trials with one intervention in the experimental group and no corresponding intervention(or other interventions)in the control group were collected.Two researchers independently read the title and abstract of the studies,preliminarily screened the articles,and read the full text in detail according to the selection criteria.Conflicts were resolved by consultation with a third researcher.And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software.RESULTS There were 25 randomized controlled trials;13 were comparative studies with or without patellar resurfacing.The meta-analysis showed no significant difference between the experimental and control groups(P=0.61).Six studies were comparative studies of circumpatellar denervation vs non-denervation,divided into three subgroups for meta-analysis.The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups(P=0.31,P=0.50).One subgroup meta-analysis showed a significant difference between the experimental and control groups(P=0.001).Two studies compared fixed-bearing TKA and mobile-bearing TKA;the results meta-analysis showed no significant difference between the experimental and control groups(P=0.630).Two studies compared lateral retinacular release vs non-release;the meta-analysis showed a significant difference between the experimental and control groups(P=0.002);two other studies compared other factors.CONCLUSION Patellar resurfacing,mobile-bearing TKA,and fixed-bearing TKA do not reduce the incidence of AKP.Lateral retinacular release can reduce AKP;however,whether circumpatellar denervation can reduce AKP is controversial.
文摘BACKGROUND Over 90%of rectal cancer patients develop low anterior resection syndrome(LARS)after sphincter-preserving resection.The current globally recognized evaluation method has many drawbacks and its subjectivity is too strong,which hinders the research and treatment of LARS.AIM To evaluate the anorectal function after colorectal cancer surgery by quantifying the index of magnetic resonance imaging(MRI)defecography,and pathogenesis of LARS.METHODS We evaluated 34 patients using the standard LARS score,and a new LARS evaluation index was established using the dynamic images of MRI defecography to verify the LARS score.RESULTS In the LARS score model,there were 10(29.41%)mild and 24(70.58%)severe cases of LARS.The comparison of defecation rate between the two groups was 29.36±14.17%versus 46.83±18.62%(P=0.004);and MRI-rectal compliance(MRI-RC)score was 3.63±1.96 versus 7.0±3.21(P=0.001).Severe and mild LARS had significant differences using the two evaluation methods.There was a significant negative correlation between LARS and MRI-RC score(P<0.001),and they had a negative correlation with defecation rate(P=0.028).CONCLUSION MRI defecography and standard LARS score can both be used as an evaluation index to study the pathogenesis of LARS.
文摘Stroke is a physiological alteration associated with changes in blood flow that can result in sudden-onset cognitive impairment. It has a heterogenous clinical presentation with varying degrees of severity correlated with specific central nervous system zones or areas, and its prognosis is uncertain. This case study describes a 62-year-old male patient with acquired brain damage of the anterior cingulate cortex as a result of an ischemic event in the territory of the left anterior cerebral artery. Cognitive function was assessed using the neuropsychological executive function and frontal lobe test battery (BANFE-2) as well as other neuropsychological tests. The results show a profile of higher mental functions characterized by the presence of dysexecutive syndrome with marked behavioral alteration and diencephalic amnesia. .
文摘Objective:To observe the clinical effect of articular cavity injection combined with bite splint therapy for the treatment of anterior disc displacement without reduction(ADDWoR).Methods:The research subjects for this study were 30 patients with ADDWoR treated in the temporomandibular joint specialist outpatient clinic from November 2018 to November 2019,with a disease duration of 1 to 6 months.The treatment group was treated with an articular cavity injection of sodium hyaluronate+bite splint.The control group was treated with a simple articular cavity injection of sodium hyaluronate.The two groups were followed up once every 2 weeks to evaluate the treatment effect and observe the clinical efficacy of the two groups.Statistical analysis was carried out using SPSS 24.0.t-test and general linear regression analysis were carried out to compare the data of both groups,andχ^(2)-test and binary logistic regression analysis were performed for pain index comparison.Results:There was no significant difference in terms of the efficacy of the treatment received by both groups.The mouth opening and joint pain of patients in both groups were significantly improved after treatment(P<0.001).Conclusion:Articular cavity injection of sodium hyaluronate and occlusal splint therapy are both effective and safe methods for treating ADDWoR.
文摘Anterior cruciate ligament(ACL)injury is one of the most common types of sports injuries.People’s need to participate in sports and desire for a high quality of life promotes the continuous development of ACL reconstruction technology.Arthroscopic ACL reconstruction has been recognized as an effective method for the treatment of ACL injuries.This review analyses and summarizes the advantages and limitations of each surgical procedure for arthroscopic ACL reconstruction reported in the relevant literature so as to promote the future development of more relevant techniques.
文摘BACKGROUND Cyclops lesions are a known complication of anterior cruciate ligament(ACL)reconstruction,with symptomatic cyclops syndrome occurring in up to 11%of surgeries.Recurrent cyclops lesions have been rarely documented;this case study documents the successful treatment of a recurrent cyclops lesion.CASE SUMMARY A 28-year-old female presented following a non-contact injury to the right knee.Workup and clinical exam revealed an ACL tear,and arthroscopic reconstruction was performed.Two years later a cyclops lesion was discovered and removed via arthroscopic synovectomy.Seven months postoperatively,the patient presented with pain,stiffness,and difficulty achieving terminal extension.A smaller recurrent cyclops lesion was diagnosed,and a repeat synovectomy was performed.The patient recovered fully.CONCLUSION To the best of our knowledge,this is the first documented case of recurrent cyclops lesion after bone-patellar tendon-bone allograft ACL reconstruction presenting as cyclops syndrome.
基金Supported by the National Natural Science Foundation of China(No.82171025No.82070934)+2 种基金the Fundamental Research Funds for the Central Universities(No.HUST:2019kfy XMBZ065)the Key Research and Development Program of Hubei Province(No.2021BCA146)the Clinical Research Foundation of Wuhan Union Hospital(No.2021xhlcyj03)。
文摘AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK).METHODS:In this noncomparative,retrospective case series,10 subjects(6 males,4 females)with a mean age of 56.5±7.1(range 47-72)y with high-risk FK undergone the two-step strategy were included.Reported outcome measures were healing of the corneal ulcer,recurrence of FK,reject reaction,improvement in best corrected visual acuity(BCVA)and relevant complications.RESULTS:The average diameter of corneal infiltrates was 7.50±0.39 mm,ranging from 6.94 to 8.13 mm.The mean depth of corneal infiltrates was 422.4±77.1μm,ranging from 350 to 535μm.The mean corneal thickness was 597.4±117.3μm,ranging from 458 to 851μm.Hypopyon and endothelial plaques were presented in all patients.The period between the two steps was 3.65±0.9(ranging from 3 to 5)mo.The graft diameter was 7.75±0.39 mm.At the last follow-up(average 9.25±3.39,ranging from 5.5 to 17mo),no fungal recurrence or graft rejection appeared,and all patients showed improvement of BCVA.One patient suffered from liver function impairment due to oral voriconazole for 4wk and recovered spontaneously after 1wk of drug withdrawal.CONCLUSION:The two-step strategy is safe and effective in the treatment of high-risk FK by transforming intentional therapeutic penetrating keratoplasty during acute infection to later optical DALK.It is a practical strategy,especially in areas lacking fresh donor corneas and eye bank services.
文摘BACKGROUND Many studies have focused on the femoral tunnel technique and fixation method,but few studies have involved the tibial tunnel technique and fixation method.The all-inside technique is one of the new techniques that has been described in recent years.All-inside anterior cruciate ligament(ACL)reconstruction is based on a tibial socket instead of a full tunnel.This method has many potential advantages.AIM To compare clinical outcomes of knee ACL autograft reconstruction using allinside quadrupled semitendinosus(AIST)and traditional hamstring tendon(TBT)techniques.METHODS From January 2017 to October 2019,the clinical data of 80 patients with ACL reconstruction were retrospectively analyzed,including 67 males and 13 females.The patients had an average age of 24.3±3.1 years(age range:18-33 years).The AIST technique was used in 42 patients and the TBT technique was used in 38 patients.The time between operation and injury,operative duration,postoperative visual analogue scale(VAS)score and knee functional recovery were recorded and compared between the two groups.The International Knee Documentation Committee(IKDC)and Lysholm scoring system were used to comprehensively evaluate clinical efficacy.RESULTS Eighty patients were followed for 24-36 mo,with an average follow-up duration of 27.5±1.8 mo.There were no significant differences in the time between surgery and injury,operative duration,IKDC and Lysholm scores of the affected knee at the last follow-up evaluation between the two groups.There were significant differences in VAS scores 1 d,3 d,7 d,2 wk and 1 mo after surgery(P<0.05).There was no significant difference in VAS score at 3 mo,6 mo and 1 year after operation.CONCLUSION The efficacy of the AIST ACL reconstruction technique was comparable to the TBT technique,but the postoperative pain was less with the AIST technique.Thus,the AIST technique is an ideal treatment choice for ACL reconstruction.
基金Supported by Iran University of Medical Sciences。
文摘AIM:To compare anterior segment parameters between two groups of type 2 diabetic with and without diabetic retinopathy(DR)and non-diabetic elderly subjects based on hemoglobin A1c(Hb A1c)levels and status of DR.METHODS:This study was conducted on 997 residents aged 60y or over in Tehran,Iran.Diabetic group had Hb A1c level≥6.4%with no other systemic problems.The non-diabetic participants had normal eye findings and no systemic diseases.K1,K2,mean K,Q-value,anterior,central,posterior,and total corneal densitometric findings,anterior chamber volume(ACV),anterior chamber depth(ACD),corneal volume(CV),and pachymetry were measured by Pentacam AXL.RESULTS:A total of 678 non-diabetic(39%male)and 319 diabetic(35%male)subjects with mean age of 66.31±5.23 and 67.22±4.96y were examined,respectively.No statistically significant difference was found in anterior segment parameters between non-diabetic and diabetic groups(all P>0.05).However,middle,posterior,and total corneal densitometric values were statistically different between two groups af ter controlling the ef fects of confounders(P=0.014,0.007,and 0.042,respectively).Corneal densitometric values in all layers,ACD,and ACV were different between diabetic subjects with and without DR(all P<0.05).In the diabetic group,only corneal densitometric values had a negative relationship with fasting blood sugar(P<0.001).ACD and ACV had a negative correlation with Hb A1c levels(all P<0.05,r=-0.129 and-0.146,respectively).However,the relationships were not observed after controlling the confounders(P=0.938,0.466,respectively).CONCLUSION:Considering the higher densitometric values of the cornea and lower ACD and ACV in diabetic subjects with DR,it is suggested that the examiners should perform comprehensive retinal examinations when faced with such conditions.
文摘Objective:To describe the outcome of female anterior wall(pubic side)onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques.Methods:From January 2016 to April 2018,17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study.The diagnosis of urethral stricture was confirmed based on a combination of patients’symptoms,post-void residual urine,video-urodynamics,and cystoscopy.Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection.Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score,post-void residual urine,and maximum flow rate.Results:Despite the previously failed minimally invasive procedures,urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes(success rateZ94%).The meanstandard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up(25.823.97 to 10.885.57);so did postvoid residual urine(71.1274.98 mL to 15.0028.30 mL),and maximum flow rate(7.881.72 mL/s to 25.825.59 mL/s)with all statistically significant(p<0.05).Conclusion:The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands.An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate.A laterally extended incision may improve visualization and better graft placement by providing wider working space.The results should be evaluated in the future studies with larger sample size.
基金Supported by the National Natural Science Foundation of China,No.82173368 and 81903047.
文摘BACKGROUND Low anterior resection syndrome(LARS)severely impairs patient postoperative quality of life,especially major LARS.However,there are few tools that can accurately predict major LARS in clinical practice.AIM To develop a machine learning model using preoperative and intraoperative factors for predicting major LARS following laparoscopic surgery of rectal cancer in Chinese populations.METHODS Clinical data and follow-up information of patients who received laparoscopic anterior resection for rectal cancer from two medical centers(one discovery cohort and one external validation cohort)were included in this retrospective study.For the discovery cohort,the machine learning prediction algorithms were developed and internally validated.In the external validation cohort,we evaluated the trained model using various performance metrics.Further,the clinical utility of the model was tested by decision curve analysis.RESULTS Overall,1651 patients were included in the present study.Anastomotic height,neoadjuvant therapy,diverting stoma,body mass index,clinical stage,specimen length,tumor size,and age were the risk factors associated with major LARS.They were used to construct the machine learning model to predict major LARS.The trained random forest(RF)model performed with an area under the curve of 0.852 and a sensitivity of 0.795(95%CI:0.681-0.877),a specificity of 0.758(95%CI:0.671-0.828),and Brier score of 0.166 in the external validation set.Compared to the previous preoperative LARS score model,the current model exhibited superior predictive performance in predicting major LARS in our cohort(accuracy of 0.772 for the RF model vs 0.355 for the preoperative LARS score model).CONCLUSION We developed and validated a robust tool for predicting major LARS.This model could potentially be used in the clinic to identify patients with a high risk of developing major LARS and then improve the quality of life.
文摘Injury to the anterior talofibular ligament(ATFL)is a common acute injury of the lateral foot ligament.Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients.The purpose of this paper is to review the anatomy and the current methods of diagnosis and treatment of acute injury to the ATFL.The clinical manifestations of acute injury to the ATFL include pain,swelling,and dysfunction.At present,non-surgical treatment is the first choice for acute injury of the ATFL.The standard treatment strategy involves the“peace and love”principle.After initial treatment in the acute phase,personalized rehabilitation training programs can be followed.These may involve proprioception training,muscle training,and functional exercise to restore limb coordination and muscle strength.Static stretching and other techniques to loosen joints,acupuncture,moxibustion massage,and other traditional medical treatments can relieve pain,restore range of motion,and prevent joint stiffness.If the non-surgical treatment is not ideal or fails,surgical treatment is feasible.Currently,arthroscopic anatomical repair or anatomical reconstruction surgery is commonly used in clinical practice.Although open Broström surgery provides good results,the modified arthroscopic Broström surgery has many advantages,such as less trauma,rapid pain relief,rapid postoperative recovery,and fewer complications,and is more popular with patients.In general,when treating acute injury to the ATFL,treatment management and methods should be timely and reasonably arranged according to the specific injury scenario and attention should be paid to the timely combination of multiple therapies to achieve the best treatment results.
基金Supported by National Institute for Medical Research Development(NIMAD)affiliated with the Iranian Ministry of Health and Medical Education(No.963660).
文摘AIM:To determine the normative distribution of axial length(AL),anterior chamber depth(ACD),anterior chamber volume(ACV),anterior chamber angle(ACA),and some of their associated factors in subjects aged 60 and over.METHODS:In this cross-sectional study,160 clusters were sampled using multi-stage cluster sampling in Tehran,Iran.After a preliminary interview,the participants underwent optometric examinations including visual acuity and refraction measurement followed by slit lamp biomicroscopy.Finally,ocular imaging was done using the Pentacam AXL to measure AL,ACD,ACV,and ACA.RESULTS:A total of 4519 eyes of 2436 participants were evaluated,of whom 58.0%(n=1412)were female.The mean age of the subjects was 67.32±6.05y(range:60-95y).The mean AL,ACD,ACV,and ACA was 23.22 mm(23.18-23.27 mm),2.61 mm(2.59-2.62 mm),126.56 mm3(125.08-128.04 mm3),and 30.61°(30.3°-30.92°),respectively.In the multivariable model,after adjusting for the effect of both eyes,the longest and shortest AL was seen in myopic and hyperopic subjects,respectively.AL,ACD,ACV and ACA were significantly larger in men compared to women(P<0.001).Except ACA,other evaluated parameters showed an inverse correlation with age(P<0.001),however,this correlation was insignificant for AL(P=0.623).CONCLUSION:Normative value of AL,and other biometric parameters are specific for each ethnicity,age and sex group.Any alteration in these parameters and their effect on refraction should be considered in this age group,especially in case of cataract surgery.
文摘BACKGROUND Anterior cruciate ligament(ACL)tears are common sports-related injuries.Their incidence is not the same either for all the sports or for the same sport across various nations.This information is maintained by many sports leagues in their registries.However,very few nationwide registries exist for such injuries.This study is carried out to know the demographic characteristics of patients who underwent ACL reconstruction at our hospital in India.AIM To know the demographic characteristics of patients who underwent ACL reconstruction at a tertiary care hospital in India.METHODS All the patients who underwent ACL reconstruction from January 2020 to December 2021 were retrospectively studied.Patients with multi-ligament injuries or a history of previous knee surgery were excluded.The patients’history was obtained from the hospital records,they were interviewed telephonically,and online questionnaires were given.Their demographic data was analyzed and compared to the existing literature.RESULTS A total of 124 patients were operated on for ACL reconstruction during this period.The mean age of the patients was 27.97 years.One hundred and thirteen patients(91.1%)were male and 11(8.9%)were female.The majority of the patients(47.6%)sustained this injury by road traffic accidents(RTA)followed by sportsrelated injuries(39.5%).The commonest presenting complaint was giving way of the knee in 118 patients(95.2%).The mean duration from the injury to the first hospital visit among the patients was 290.1 d.The mean duration from the injury to surgery was 421.8 d.CONCLUSION ACL patients’demography is different in developing nations as compared to the developed world.RTA are the leading cause of ACL injuries and are followed by recreational sports as a cause.There is delayed access to healthcare leading to delayed diagnosis as well as even greater time to surgery.This,in turn,leads to poorer prognosis and longer rehabilitation.National registries for developing nations are the need of the hour due to the different demographics of ACL injuries in developing countries.
文摘Objective This study aimed to compare the postoperative analgesia and recovery of ultrasound-guided erector spinae plane block combined with serratus anterior plane block(ESPB combined with SAPB)versus thoracic paravertebral block(PVB)after thoracoscopic surgery.Methods Ninety-two patients who underwent video-assisted thoracoscopic surgery(VATS)were randomly divided into group S(n=46)and group P(n=46).After anesthesia induction,the same anesthesiologist performed ultrasound-guided ESPB at T5 and T7 levels combined with SAPB at the level of the fifth rib in the midaxillary line in group S and ultrasound-guided PVB at T5 and T7 levels in group P.Patients in both groups were given 40 mL of 0.4%ropivacaine.Eighty-six patients completed the study(group S,n=44;group P,n=42).The morphine consumption,visual analogue scale(VAS)scores at rest and coughing,and frequency of remedial analgesia were recorded at 1,2,4,8,and 24 h postoperatively.Pulmonary function parameters were recorded at 1,4,and 24 h postoperatively,and the quality of recovery(QoR)-15 score at 24 h postoperatively.The adverse effects,duration of chest tube drainage and length of stay were also recorded.Results The morphine consumption at postoperative 4 and 8 h and the incidence of ipsilateral shoulder pain(ISP)were significantly lower in group S than in group P.The QoR-15 questionnaire score at postoperative 24 h was significantly lower in group P than in group S(P<0.05).The morphine consumption was lower at 24 h postoperatively in group S than in group P,with no significant difference found yet.The morphine consumption at other observed times,VAS scores,pulmonary function parameters,frequency of remedial analgesia,duration of chest tube drainage,length of stay,and incidence of other adverse events were comparable between group S and group P.Conclusion Ultrasound-guided ESPB combined with SAPB is non-inferior to PVB in terms of morphine consumption at postoperative 24 h and postoperative recovery.But,this approach can significantly reduce morphine consumption in the early postoperative period(0–8 h)after thoracoscopy with lower incidence of ISP.It is a simpler and safer operation.
基金Supported by The Natural Science Foundation of Shandong Province,No.ZR2018BH013The China Postdoctoral Science Foundation,No.2017M612214.
文摘BACKGROUND Inferior oblique anterior transposition(IOAT)has emerged as an effective surgery in the management of dissociated vertical deviation(DVD)combined with superior oblique palsy(SOP).Traditional IOAT usually provides satisfactory primary position alignment and simultaneously restricts the superior floating phenomenon.However,it also increases the risk of the anti-elevation syndrome and narrowing of the palpebral fissure in straight-ahead gaze,especially after the unilateral operation.CASE SUMMARY We report the outcomes of the modified unilateral IOAT in two patients with unilateral DVD combined with SOP.The anterior-nasal fibers of the inferior oblique muscle were attached at 9 mm posterior to the corneal limbus along the temporal board of the inferior rectus muscle,the other fibers were attached a further 5 mm temporal to the anterior-nasal fibers.Postoperatively,both hypertropia and floating were improved,and no obvious complications occurred.CONCLUSION In these cases,the modified unilateral IOAT was an effective and safe surgical method for treating DVD with SOP.
基金Supported by the Program for Zhejiang Leading Talent of S&T Innovation(No.2021R52012)Key Research and Development Projects of Zhejiang Province(No.2022C03112)the Basic Scientific Research Program of Wenzhou(No.Y2020365).
文摘AIM:To describe the outcome of using low-dose laser cycloplasty(LCP)in chronic angle-closure glaucoma(CACG).METHODS:A retrospective case series.Medical charts of CACG patients who underwent LCP in the Eye Hospital of Wenzhou Medical University were reviewed.The main outcomes included intraocular pressure(IOP),the number of glaucoma medication,anterior segment parameters and surgery-related complications.RESULTS:A total of 7 eyes of 7 CACG patients(age 38.9±11.0y)underwent LCP with a mean follow-up of 27.1±13.7mo(range 16-48mo).Following LCP,mean IOP and glaucoma medications decreased from 26.1±6.1 mm Hg with 3.1±1.1 glaucoma medications pre-treatment to 14.9±3.1 mm Hg(P=0.027)with 0.4±1.1 glaucoma medications(P=0.001)at final follow-up.The anterior chamber depth(ACD),angle opening distance500 and trabecular-iris angle increased from 1.65±0.33 mm,0.05 mm(range 0-0.30 mm)and 5.1°(range,0-31.97°)at baseline to 1.98±0.43 mm(P=0.073),0.53 mm(range 0.42-0.91 mm,P=0.015),45.9°(range,40.2°-59.4°),(P=0.015)in the long-term follow-up,respectively.The deepening of ACD and reopening of anterior chamber angle(ACA)was observed in 6 eyes(85.7%).CONCLUSION:LCP is a promising treatment option for patients with CACG via reducing IOP and glaucoma medication without serious complications.In addition,LCP can bring a significant deepening in ACD and reopening of ACA.
