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Background: Neoadjuvant chemoradiotherapy for rectal cancer improves surgical outcomes and reduces recurrence but can cause low anterior resection syndrome (LARS), affecting quality of life. This study aims to predict the risk of LARS in male patients with mid-low rectal cancer after laparoscopic total mesorectal excision (TME). Methods: Clinical data from 203 male patients with mid-low rectal cancer who underwent neoadjuvant therapy and laparoscopic resection were collected. Patients were divided into training (n=143) and validation (n=60) cohorts. LARS risk factors were identified using logistic regression, and a predictive model was constructed and validated using ROC curve, Hosmer-Lemeshow test, calibration curve, and decision curve analysis (DCA). Results: LARS occurred in 53.6% of the patients in this study. Multivariate logistic regression analysis revealed that BMI ≥ 25 kg/m², tumor distance from the anal margin < 5 cm, radiotherapy, and anastomotic leakage were independent risk factors for postoperative LARS in patients (P < 0.05). The areas under the ROC curves for the training cohort and validation cohort were 0.866 (95% CI: 0.807-0.925) and 0.724 (95% CI: 0.595-0.853), respectively, with both groups showing good goodness-of-fit test results (P > 0.05). The DCA curve indicated that the model had a high clinical utility. Conclusions: BMI ≥ 25 kg/m², tumor distance from the anal margin < 5 cm, radiotherapy, and anastomotic leakage are independent risk factors for the occurrence of LARS after neoadjuvant therapy combined with laparoscopic TME in male patients with mid-low rectal cancer. These factors should be emphasized in clinical practice, and corresponding preventive measures should be promptly implemented. [ABSTRACT FROM AUTHOR]

Simple Summary: Low anterior resection syndrome (LARS) encompasses a multitude of gastrointestinal symptoms that arise secondary to low and very-low anterior rectal resection performed for rectal cancer. This syndrome can affect a significant percentage of patients and impacts life for varying periods or may become permanent, requiring conversion to a permanent colostomy. For this reason, LARS has begun to be studied and recognized by surgeons and oncologists, and patients must be informed about the possibility of developing this condition after curative surgery. The study was conducted on 102 patients diagnosed and operated on for upper, middle, and lower rectal neoplasm, where resection was accompanied by partial or total mesorectal excision, and who exhibited at least one symptom associated with LARS. Obesity, the size of the remaining rectum, total mesorectal excision, anastomotic complications, and prolonged ileostomy time are convergent factors in the etiology of LARS. Objectives: The aim of the study was to assess the diagnosis and evolution of low anterior rectal resection syndrome (LARS) in patients admitted to a tertiary surgical center in Romania. Materials and Methods: From 120 patients initially included in the analysis, after applying the exclusion criteria, we selected 102 patients diagnosed and operated on for neoplasm of the upper, middle, and lower rectum for which resection and excision (partial or total) of mesorectum was associated. All the patients we treated in the general surgery department of the County Emergency Hospital of Craiova within a time frame of 5 years (1 October 2017–1 September 2022), and all experienced at least one symptom associated with LARS. The group included 68 men and 34 women aged between 35 and 88, who were followed-up for at least 2 years. Patients with progression of neoplastic disease, with advanced neurological disease, and those who died less than 2 years after surgery were excluded. Results: The overall incidence varied by gender, site of the tumor (requiring a certain type of surgery), and anastomotic complications, and it was directly proportional to the time interval between resection and restoration of continuity of digestion. Conclusions: Obesity, size of the remaining rectum, total excision of the mesorectum, anastomotic complications, and prolonged ileostomy time are cofactors in the etiology of LARS. The LARS score decreased in most patients during the 2-year follow-up, although there were a small number of patients in whom the decrease was insignificant. The persistence of major LARS at 6 months after surgery may predict the need for a definitive colostomy. [ABSTRACT FROM AUTHOR]

Background: This study aims to establish a consensus-based standard protocol for transanal irrigation (TAI) in patients with low anterior resection syndrome (LARS) and functional constipation. Methods: The Delphi method was utilized to reach a consensus among clinicians and nurses expert in the field of colorectal surgery and gastroenterology. To address various uncertainties concerning technical aspects, difficulties, and prescription of TAI, two questionnaires were developed and analyzed in two rounds. A binary approach was employed, setting a consensus threshold of 75% agreement. Results: In the first round, nurses achieved consensus on all statements, while clinicians required a second round to reach consensus, particularly regarding prescription and technical aspects. Clinicians reached consensus on prescribing TAI as a second-line treatment for LARS and functional constipation, following the failure of conservative measures such as dietary and lifestyle interventions. Timing considerations for patients with LARS encompass avoiding TAI within 1 month of stoma closure and waiting a minimum of 3 months. For functional constipation, TAI is recommended for slow transit constipation, emphasizing its preference over surgical options. Consensus was also reached on the choice of catheter for patients with LARS, training requirements for patients and caregivers, preparation of the patient's intestine before TAI, and recommended irrigations. Conclusions: This consensus study successfully developed a standardized TAI protocol for LARS and functional constipation. It provides comprehensive guidelines for prescription and technical aspects, addressing the challenges encountered by healthcare professionals. The protocol aims to enhance patient care, improve treatment outcomes, and contribute to the advancement of TAI. [ABSTRACT FROM AUTHOR]

Background: There have been emerging clinical trials investigating the efficacy of synthetic-graft-augmented autografts in anterior cruciate ligament reconstruction (ACLR) in recent years. Hamstring tendon and Ligament Augmentation and Reconstruction System (LARS) are both widely discussed graft choices for ACLR. Purpose: To compare the clinical efficacy of hamstring tendon grafts with LARS-augmented hamstring tendon grafts in ACLR. Study Design: Systematic review and meta-analysis. Method: A systematic literature search was performed in PubMed, Embase and the Cochrane Library to identify primary evidence related to the comparison of ACLR with a hamstring tendon (HT) versus a hamstring tendon with LARS (HT + LARS). Quality assessment of the included studies was conducted using Newcastle–Ottawa Scale for non-RCTs. Quantitative analysis was conducted with Reviewer Manager 5.4. The primary outcomes compared were the Lysholm scale, Tegnar activity scale, International Knee Documentation Committee (IKDC) evaluation, KT-1000-based laxity, complication/retear rate and rate of return-to-sports. The secondary outcomes were the Knee Injury and Osteoarthritis Outcomes Score (KOOS), Global Rating of Change (GRC) scale, hop tests, isokinetic knee strength tests and radiographic and arthroscopic evaluations. Results: Six cohort studies with 710 participants were included in this study. Compared with the HT group, the HT + LARS group had better Lysholm scores at the 1-year follow-up (P = 0.0007) and at the final follow-up (P = 0.04). HT + LARS group had better IKDC scores at the 1-year follow-up (P = 0.003). The HT + LARS group had a better return-to-sports rate in short term. No significant difference in complications or re-surgery was observed. The secondary results revealed superior or non-inferior outcomes in the HT + LARS group. Conclusions: As grafts for ACLR, the use of hamstring tendons with LARS augmentation, compared with the use of hamstring tendons alone, in the short term, has significantly superior overall functional results and better early sports participation and non-inferior results in other comparisons. In the long term, the use of hamstring tendon with LARS augmentation demonstrated non-inferior results in terms of functional scores, knee stability, knee strength, complications and re-tear rate, etc. [ABSTRACT FROM AUTHOR]

Abstract Background There have been emerging clinical trials investigating the efficacy of synthetic-graft-augmented autografts in anterior cruciate ligament reconstruction (ACLR) in recent years. Hamstring tendon and Ligament Augmentation and Reconstruction System (LARS) are both widely discussed graft choices for ACLR. Purpose To compare the clinical efficacy of hamstring tendon grafts with LARS-augmented hamstring tendon grafts in ACLR. Study Design Systematic review and meta-analysis. Method A systematic literature search was performed in PubMed, Embase and the Cochrane Library to identify primary evidence related to the comparison of ACLR with a hamstring tendon (HT) versus a hamstring tendon with LARS (HT + LARS). Quality assessment of the included studies was conducted using Newcastle–Ottawa Scale for non-RCTs. Quantitative analysis was conducted with Reviewer Manager 5.4. The primary outcomes compared were the Lysholm scale, Tegnar activity scale, International Knee Documentation Committee (IKDC) evaluation, KT-1000-based laxity, complication/retear rate and rate of return-to-sports. The secondary outcomes were the Knee Injury and Osteoarthritis Outcomes Score (KOOS), Global Rating of Change (GRC) scale, hop tests, isokinetic knee strength tests and radiographic and arthroscopic evaluations. Results Six cohort studies with 710 participants were included in this study. Compared with the HT group, the HT + LARS group had better Lysholm scores at the 1-year follow-up (P = 0.0007) and at the final follow-up (P = 0.04). HT + LARS group had better IKDC scores at the 1-year follow-up (P = 0.003). The HT + LARS group had a better return-to-sports rate in short term. No significant difference in complications or re-surgery was observed. The secondary results revealed superior or non-inferior outcomes in the HT + LARS group. Conclusions As grafts for ACLR, the use of hamstring tendons with LARS augmentation, compared with the use of hamstring tendons alone, in the short term, has significantly superior overall functional results and better early sports participation and non-inferior results in other comparisons. In the long term, the use of hamstring tendon with LARS augmentation demonstrated non-inferior results in terms of functional scores, knee stability, knee strength, complications and re-tear rate, etc.

El ligamento cruzado anterior es el ligamento de la rodilla que se lesiona con más frecuencia, casi la mitad de todas las lesiones de rodilla. Este grupo de pacientes se beneficia de la reconstrucción del ligamento mediante distintos tipos de intervenciones siendo el LARS uno de los más efectivos. El objetivo es analizar la efectividad en reconstrucción de ligamento cruzado anterior en pacientes con sistema de reconstrucción de ligamento cruzado anterior sintético LARS en la unidad de rodilla del Centro Médico Docente la Trinidad en el periodo enero 2014 - agosto del 2024. Es un estudio de tipo documental, de temporalidad retrospectiva, cohorte cerrada con la selección aleatoria de una muestra de 30 historias clínicas de pacientes en quienes fue aplicado el sistema LARS para la reconstrucción de ligamento cruzado anterior durante los años 2014 a 2024. Se evaluó un total de 30 pacientes, de los cuales 26 (86,5 %) son considerados como éxito terapéutico, con un predominio del sexo masculino para una relación de 6,5:1 y una edad promedio de 41,3 + 12,4 años, con una distribución equitativa entre los grupos etarios, se presentó una modificación estadísticamente significativa entre los valores de TLs score entre evaluación inicial y actual; en los pacientes considerados como falla terapéutica, se identificaron factores de riesgo modificables como la ausencia del cumplimiento de la rehabilitación y mantenimiento de actividad física de alto impacto articular. La intervención LARS es un método efectivo y eficaz para el tratamiento de lesiones de LCA.

BackgroundNeoadjuvant chemoradiotherapy for rectal cancer improves surgical outcomes and reduces recurrence but can cause low anterior resection syndrome (LARS), affecting quality of life. This study aims to predict the risk of LARS in male patients with mid-low rectal cancer after laparoscopic total mesorectal excision (TME).MethodsClinical data from 203 male patients with mid-low rectal cancer who underwent neoadjuvant therapy and laparoscopic resection were collected. Patients were divided into training (n=143) and validation (n=60) cohorts. LARS risk factors were identified using logistic regression, and a predictive model was constructed and validated using ROC curve, Hosmer-Lemeshow test, calibration curve, and decision curve analysis (DCA).ResultsLARS occurred in 53.6% of the patients in this study. Multivariate logistic regression analysis revealed that BMI ≥ 25 kg/m², tumor distance from the anal margin < 5 cm, radiotherapy, and anastomotic leakage were independent risk factors for postoperative LARS in patients (P < 0.05). The areas under the ROC curves for the training cohort and validation cohort were 0.866 (95% CI: 0.807-0.925) and 0.724 (95% CI: 0.595-0.853), respectively, with both groups showing good goodness-of-fit test results (P > 0.05). The DCA curve indicated that the model had a high clinical utility.ConclusionsBMI ≥ 25 kg/m², tumor distance from the anal margin < 5 cm, radiotherapy, and anastomotic leakage are independent risk factors for the occurrence of LARS after neoadjuvant therapy combined with laparoscopic TME in male patients with mid-low rectal cancer. These factors should be emphasized in clinical practice, and corresponding preventive measures should be promptly implemented.

OBJECTIVE: Our study aimed to determine the impact of pelvic floor muscle training (PFMT) on sphincter function and overall well-being in patients who underwent low anterior resection (LAR) and diverting ileostomy due to rectal cancer. For this purpose, anal electromyography (aEMG), low anterior resection syndrome (LARS) score, and the European Organization for Research and Treatment of Cancer quality-of-life questionnaires (EORTC-QLQ)-C30 (generic for cancer) and CR29 (specific to colorectal cancer) were used. The primary endpoint of our study is to determine the effect of PFMT on sphincter function by aEMG, the secondary endpoint is to evaluate the effect on quality-of-life using the LARS score, EORTC-QLQ-C30 and CR-29 questionnaires. METHODS: Conducted between January 2017 and April 2018 at a tertiary hospital's general surgery clinic, the study included 32 patients between the ages of 18 and 75 who underwent low anterior resection and diverting ileostomy surgery. The patients were divided into two: the Study Group (SG), which started PFMT after surgery, and the Control Group (CG), which was not subjected to additional exercises. Six months after closure of the diverting ileostomy, both groups were evaluated with aEMG, LARS scores, and EORTC-QLQ-C30 and CR-29. RESULTS: aEMG duration values were significantly lower in the SG (17.6 m/sec vs. 19.9 m/sec; p=0.001). Additionally, a significant decrease in SG, major LARS rates (12.5% vs. 62.5%; p=0.004) and LARS scores (23.1 vs. 30.0; p=0.003) was observed. While there was no significant difference between the groups in EORTC-QLQ C30, increased sexual interest and decreased fecal incontinence were observed in SG in EORTC-QLQ-CR29. CONCLUSION: PFMT significantly improves LARS scores, quality-of-life questionnaires and aEMG parameters, positioning PFMT as an accessible, non-invasive, easy-to-use first-line treatment option in the treatment of LARS. [ABSTRACT FROM AUTHOR]

BACKGROUND: In recent years, the treatment of anterior cruciate ligament injury has become more and more mature. However, there are still disputes about the timing of surgery, the choice of surgical methods, the choice of grafts, and the methods to promote graft healing after anterior cruciate ligament injury. OBJECTIVE: To summarize the latest research progress of surgical timing, surgical methods, graft selection and methods to promote graft healing after anterior cruciate ligament injury, and to find new treatment directions for anterior cruciate ligament injury. METHODS: Relevant articles concerning anterior cruciate ligament injury were retrieved from PubMed, CNKI, WanFang Date, VIP, SinoMed, ScienceDirect, Springer and Cochrane Library. After the screening, 72 related articles were finally included. RESULTS AND CONCLUSION: (1) Surgical timing: Compared with delayed anterior cruciate ligament reconstruction, early reconstruction can reduce meniscus injury, elevate quality of life, and improve functional recovery. However, it is still uncertain whether the different operation timing will accelerate cartilage injury. (2) Surgical methods: Arthroscopic anterior cruciate ligament reconstruction is a common surgical method for anterior cruciate ligament injury. Dynamic internal stabilization repair of anterior cruciate ligament can bring similar results to traditional anterior cruciate ligament reconstruction in short-term and long-term effects. (3) Graft selection: Autogenous hamstring tendon is the first choice of anterior cruciate ligament graft, while bone-patellar tendon-bone grafts and allografts are the secondary choices. (4) Among the methods to promote graft healing, suture band strengthening can increase knee joint stability and ensure graft healing. Stem cells promote the tendon-bone healing of grafts through anti-inflammatory action, angiogenesis, inhibition of osteolysis and promotion of chondrocyte differentiation. Preserving the residual end of the anterior cruciate ligament can maintain the stability of the knee joint, promote the recovery of proprioception, and provide a prerequisite for the healing of the graft. The effectiveness of platelet-rich plasma in promoting graft healing remains to be discussed. However, biomaterials, gene therapy, stem cell application and other methods to promote tendon healing remain in the stage of molecular and animal researches. Clinical transformation is also needed in the future. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the long-term functional and MRI results of 35 patients who underwent bicruciate ligament reconstruction combining an ACL autograft using the gracilis and semitendinosus tendons and double-bundle PCL reconstruction using the LARS artificial ligament. Methods: The outcomes were measured using the Lysholm score, the Tegner activity level scale and the International Knee Documentation Committee form (IKDC 2000). KT-1000 was used to assess the clinical anterior knee laxity. Radiographs and Magnetic Resonance Imaging (MRI) was used to evaluate osteoarthritis, the continuity and integrity of ACL autograft and LARS. Results: This retrospective study examined 35 patients who underwent single-stage bicruciate ligament reconstruction between May 2005 and January 2017 with a follow-up period ranging from 3 to 15 years (a mean of 7.5 years). The mean Lysholm score was 74, mean IKDC 2000 was 71. There was a statistically significant difference with a higher Lysholm score (78.9) in early versus delayed surgical intervention (p = 0.023). Using the Kellgren Lawrence osteoarthritis classification system, radiographic findings showed stage II or III in 83% of the sample population. The MRI results revealed a rupture rate of 22% of the anterior autografted ligament and 28% of the posterior LARS artificial ligament. However, there were no long-term artificial ligament-induced complications. There was no correlation between artificial ligament rupture and poor functional results (Lysholm < 65). Conclusion: The results of this study with a mean follow-up of 7.5 years show satisfactory functional scores considering the initial trauma. It seems reasonable to propose early surgical treatment with double reconstruction of the cruciate ligaments within the first 21 days of the trauma. Post-traumatic osteoarthritis is inevitable in multi-ligament knee injuries despite anatomical reconstruction. The use of a LARS artificial ligament appears to be a valid alternative for PCL reconstruction in the context of multi-ligament injury and in the absence of sufficient autologous transplants. [ABSTRACT FROM AUTHOR]

Aim: Physiotherapy is an established treatment strategy for low anterior resection syndrome (LARS). However, data on its efficacy are limited. This is in part due to the inherent challenges in study design in this context. This systematic review aims to analyse the methodology of studies using pelvic floor physiotherapy for treatment of LARS to elucidate the challenges and limitations faced, which may inform the design of future prospective trials. Methodology: A systematic review of the literature was undertaken through MEDLINE, Embase and Cochrane Library, yielding 345 unique records for screening. Five studies were identified for review. Content thematic analysis of study limitations was carried out using the Braun and Clarke method. Line‐by‐line coding was used to organize implicit and explicit challenges and limitations under broad organizing categories. Results: Key challenges fell into five overarching categories: patient‐related issues, cancer‐related issues, adequate symptomatic control, intervention‐related issues and measurement of outcomes. Adherence, attrition and randomization contributed to potential bias within these studies, with imbalance in the baseline patient characteristics, particularly gender and baseline pelvic floor function scores. Outcome measurements consisted of patient‐reported measures and quality of life measures, where significant improvements in bowel function according to patient‐reported outcome measures were not reflected in the quality of life scores. Conclusion: Upcoming trial design in the area of pelvic floor physiotherapy for faecal incontinence related to rectal cancer surgery can be cognisant of and design around the challenges identified in this systematic review, including the reduction of bias, exclusion of the placebo effect and the potential cultural differences in attitude towards a sensitive intervention. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work was to evaluate the concordance between the low anterior resection syndrome (LARS) and preoperative LARS (POLARS) scores regarding the incidence of LARS in a Chilean population undergoing rectal surgery for cancer in a high‐volume hospital. Method: The LARS score questionnaire, following telephone requests, was used to determine the presence and severity of LARS. The POLARS score was calculated based on variables described previously. Correlations and qualitative and quantitative concordance were evaluated using Spearman's correlation coefficient, the kappa coefficient and the Bland–Altman plot with Lin's concordance correlation coefficient. Results: A total of 120 patients met the inclusion criteria: 37.5% underwent neoadjuvant radiotherapy, 61% underwent total mesorectal excision (TME) and 51.6% underwent ostomy. A total of 49% of patients did not present with LARS, whereas 28% had major LARS. The correlation between scales was poor, with a fair qualitative concordance to determine the presence/absence of LARS and a slight qualitative concordance to determine the degree of the intensity. The quantitative concordance was poor. Conclusion: In the Chilean population, concordance between the LARS and POLARS scores was qualitatively fair to determine the presence/absence of the disease and qualitatively slight to determine the degree of intensity. We do not suggest using the POLARS score in the perioperative period in the Chilean population deliberately, as the score may help to determine the presence/absence of LARS but cannot determine its degree of intensity. Additional evaluations are required to determine the factors contributing to the degree of agreement between the scales. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to examine the efficacity and safety of ondansetron, a serotonin receptor antagonist, to treat patients with low anterior resection syndrome (LARS). Background: LARS after rectal resection is common and debilitating. Current management strategies include behavioral and dietary modifications, physiotherapy, antidiarrheal drugs, enemas, and neuromodulation, but the results are not always satisfactory. Methods: This is a randomized, multicentric, double-blinded, placebo-controlled, and cross-over study. Patients with LARS (LARS score >20) no longer than 2 years after rectal resection were randomized to receive either 4 weeks of ondansetron followed by 4 weeks of placebo (O-P group) or 4 weeks of placebo followed by 4 weeks of ondansetron (P-O group). The primary endpoint was LARS severity measured using the LARS score; secondary endpoints were incontinence (Vaizey score) and irritable bowel syndrome quality of life (IBS-QoL questionnaire). Patients' scores and questionnaires were completed at baseline and after each 4-week treatment period. Results: Of 46 randomized patients, 38 were included in the analysis. From baseline to the end of the first period, in the O-P group, the mean (SD) LARS score decreased by 25% [from 36.6 (5.6) to 27.3 (11.5)] and the proportion of patients with major LARS (score >30) went from 15/17 (88%) to 7/17 (41%), (P=0.001). In the P-O group, the mean (SD) LARS score decreased by 12% [from 37 (4.8) to 32.6 (9.1)], and the proportion of major LARS went from 19/21 (90%) to 16/21 (76%). After crossover, LARS scores deteriorated again in the O-P group receiving placebo, but further improved in the P-O group receiving ondansetron. Mean Vaizey scores and IBS QoL scores followed a similar pattern. Conclusions: Ondansetron is a safe and simple treatment that appears to improve both symptoms and QoL in LARS patients. [ABSTRACT FROM AUTHOR]

Abstract Background Rectal cancer is commonly treated by chemoradiation therapy, followed by the low anterior resection anal sphincter-preserving surgery, with a temporary protecting ileostomy. After reversal of the stoma a condition known as low anterior resection syndrome (LARS) can occur characterized by a combination of symptoms such as urgent bowel movements, lack of control over bowel movements, and difficulty fully emptying the bowels. These symptoms have a significant negative impact on the quality of life for individuals who have survived the cancer. Currently, there is limited available data regarding the presence, risk factors, and effects of treatment for these symptoms during long-term follow-up. Aims To evaluate long term outcomes of low anterior resection surgery and its correlation to baseline anorectal manometry (ARM) parameters and physiotherapy with anorectal biofeedback (BF) treatment. Methods One hundred fifteen patients (74 males, age 63 ± 11) who underwent low anterior resection surgery for rectal cancer were included in the study. Following surgery, patients were managed by surgical and oncologic team, with more symptomatic LARS patients referred for further evaluation and treatment by gastroenterologists. At follow up, patients were contacted and offered participation in a long term follow up by answering symptom severity and quality of life (QOL) questionnaires. Results 80 (70%) patients agreed to participate in the long term follow up study (median 4 years from stoma reversal, range 1–8). Mean time from surgery to stoma closure was 6 ± 4 months. At long term follow up, mean LARS score was 30 (SD 11), with 55 (69%) patients classified as major LARS (score > 30). Presence of major LARS was associated with longer time from surgery to stoma reversal (6.8 vs. 4.8 months; p = 0.03) and with adjuvant chemotherapy (38% vs. 8%; p = 0.01). Patients initially referred for ARM and BF were more likely to suffer from major LARS at long term follow up (64% vs. 16%, p

Purpose: The aim of the present study was to evaluate the pooled efficacy of percutaneous tibial nerve stimulation (PTNS) in patients with low anterior resection syndrome (LARS). Material and Methods: This study was based on the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The primary endpoint was the pooled effect size of PTNS in LARS score (LARSS). Secondary endpoints included incontinence (Fecal Incontinence Score—FIC, Obstructive Defecation Syndrome—ODS), sexual functionality and quality of life (QoL) questionnaires, and manometric evaluations. Continuous outcomes were reported as weighted mean difference (WMD), with the corresponding 95% confidence interval (95% CI). Quality evaluation was performed via the National Institutes of Health (NIH) quality assessment tool. Results: Overall, 5 studies were included. PTNS resulted to reduced LARSS values (WMD: − 5.68, 95%CI: − 7.73, − 3.63, p < 0.001). A similar effect was noted in St Mark's FIC (p < 0.001) and ODS (p = 0.02) score. An improvement in several QoL scales was found. There was no effect in sexual functionality and manometric measurements. Compared to sham, PTNS significantly improved LARSS. Conclusions: The application of PTNS in patients with LARS results in an improvement in multiple clinical parameters, including defecation functionality and quality of life. Due to several study limitations, further high quality RCTs are required to delineate the exact efficacy of PTNS. [ABSTRACT FROM AUTHOR]

Patients subjected to low anterior resection for rectal cancers experience a constellation of symptoms of disordered bowel function which leads to a detriment in the quality of life. The LAR syndrome (LARS) score is a self-administered questionnaire to identify and assess disordered bowel function after resective surgery. The objective of this study was to validate the Urdu version of the LARS score. The translation process was carried out in a fashion outlined by the original authors of the LARS score after obtaining proper permission. The validation of the translated version included the assessment of its reliability, convergent and discriminant validities, internal consistency, and confirmatory analyses. A total of 60 patients were enrolled in the study with a 95% power of study. The translated questionnaire was initially administered to a random subgroup of patients to verify the adequacy and degree of comprehension of questions. Then reproducibility was investigated by a test–retest procedure. An analysis was then done to determine the correlation between Urdu LARS score and a quality of life related question that was included along with the questionnaire. The Urdu version of the LARS score demonstrates a high convergent validity in terms of its correlation with self-reported quality of life. It also demonstrated its efficacy to discriminate between clinical variables expected to differ with regards to LARS. There was almost perfect agreement in the test and retest values demonstrating good reliability across all instruments. The Urdu version of the LARS score has proven to be a reliable and a valid tool for measuring LARS in the Urdu speaking population of the Indian subcontinent. [ABSTRACT FROM AUTHOR]

Accompanied by the significant progress of deep learning in various fields, target detection, an important branch in the field of deep learning, is gradually being applied in educational scenarios. In this paper, using the GCT-YOLOv5 algorithm and the Lasso-LARs algorithm, we studied how to improve the interactive efficiency of college English classroom teaching Research first combines the YOLOv5 model with the GCT unit, constructs the GCT-YOLOv5 target detection model for students’ classroom behaviors, and compares it with Fast-RCNN, SSD, YOLOv3, YOLOv4, and YOLOv5 in the public dataset and the student classroom behavior dataset for comparison experiments, respectively. Then, the LASSO-LARS algorithm is used to construct the classroom behavior scoring model, adjust classroom teaching interactions according to the scoring results, and analyze the effect of the adjustment. On the classroom behavior dataset, the GCT-YOLOv5 model is 98.81%, second only to Fast-RCNN, and improves 0.65% relative to the original model YOLOv5. Its inference time compared to YOLOv5 inference time increased by only 0.13h, shorter than other models. The GCT-YOLOv5 model in this paper has better applicability and timeliness in general. Teaching interaction adjustment based on the results of classroom behavior analysis can improve students’ classroom performance as well as their academic performance, i.e., enhance the efficiency of teaching interaction and provide a way of thinking about how to monitor learners’ learning status in a smart classroom.

Introduction: There is an ongoing debate on surgical techniques for colorectal deep endometriosis (DE) and their effects on gastrointestinal (GI) function. The aim of this study was to prospectively investigate the differences in pre‐ and postsurgical GI function, health profiles and pain symptoms in women undergoing colorectal surgery for symptomatic DE either with a modified segmental resection technique, so‐called nerve‐vessel sparing segmental resection (NVSSR), or full thickness discoid resection (FTDR). Complication rates and fertility outcomes were also evaluated. Material and methods: A total of 162 consecutive patients, 125 (77.2%) of whom underwent NVSSR and 37 (22.8%) FTDR, were evaluated regarding complication rates. Furthermore a lower anterior resection syndrome (LARS) scores, gastrointestinal function‐related quality of life index (GIQLI), pain symptoms, endometriosis health profile (EHP‐30) parameters were analyzed pre‐ and post‐surgery in a final cohort of 121 patients. Results: There was no difference between postsurgical prevalence of LARS in either surgery group (14/98, 14.1% NVSSR; 2/23, 8.6% FTDR), with significantly decreased LARS scores and increased GIQLI values before vs after surgery in both groups (P < 0.001). The overall grade III complication rate was 7/162 (4.3%) with no significant differences between NVSSR and FTDR groups. Overall, EHP‐30 and pain scores significantly decreased after a median follow‐up of 41 (± 17.6) months (EHP‐30 51.1, SD 21.5 vs 12.7, SD 19.3, P < 0.001; dysmenorrhea, dyspareunia, dyschezia all P < 0.001 both cohorts, respectively). The overall life birth rate and postsurgical pregnancy in infertile patients undergoing NVSSR and FTDR was respectively 58.1% in 25/43 patients; 55.6% in 5/9 patients; 56.0% in 14/25 patients and 100% in 5/5 patients. Conclusions: NVSSR and FTDR for symptomatic colorectal DE confer a significant amelioration of GI function reflected by decreased LARS symptoms and increased GIQLI scores with no differences in postsurgical function in between the two techniques. Both techniques confer similar complication rates and effects on pain reduction and health profiles. [ABSTRACT FROM AUTHOR]

Background: Rectal cancer is frequent and often treated with sphincter-saving procedures that may cause LARS, a syndrome characterized by symptoms of bowel disfunction that may severely affect quality of life. LARS is common, but its pathogenesis is mostly unknown. The aim of this study is to assess the incidence of LARS and to identify potential risk factors. Methods: We performed an observational retrospective single center analysis. The following data were collected and analyzed for each patient: demographics, tumor-related data, and intra- and peri-operative data. Statistical analysis was conducted, including descriptive statistics and multivariate logistic regression to identify independent risk factors. Results: Total LARS incidence was 31%. Statistically significant differences were found in tumor distance from anal verge, tumor extension (pT and diameter) and tumor grading (G). Multivariate analysis identified tumor distance from anal verge and tumor extension as an independent predictive factor for both major and total LARS. Adjuvant therapy, although not significant at univariate analysis, was identified as an independent predictive factor. Time to stoma closure within 10 weeks seems to reduce incidence of major LARS. Conclusions:bold LARS affects a considerable portion of patients. This study identified potential predictive factors that could be useful to identify high risk patients for LARS. [ABSTRACT FROM AUTHOR]

Aim: Restorative proctectomy is commonly associated with significant bowel dysfunction, known as low anterior resection syndrome (LARS), which has a negative impact on patients' quality of life. We developed an online patient‐centred application on LARS (eLARS) for rectal cancer survivors. The primary objective of this study was to assess the feasibility of eLARS for rectal cancer survivors with LARS following restorative proctectomy. The secondary objective was to explore participants' experiences with LARS and the eLARS application. Methods: This was a mixed methods study, which included a feasibility and qualitative analysis. Participants were rectal cancer survivors who underwent restorative proctectomy for rectal cancer within 3 years, completed all adjuvant treatment, and suffered from bowel dysfunction postoperatively. Participants were given access to the application over a 2‐month study period. Feasibility was defined as 75% of study participants using the application ≥4 times per month. Semi‐structured interviews were conducted with participants after the study period and were analysed using thematic analysis. Results: Our sample included eight rectal cancer survivors, five women and three men. The median age was 58.5 years (56.5–64.5). Most participants (75%) were >1‐year post‐restorative proctectomy. 75% of study participants used the application ≥4 times per month for 2 months. Our thematic analysis revealed that participants felt that they lacked access to credible information and emotional support around the time of ileostomy closure, and found that eLARS addressed these challenges. Conclusion: eLARS is a feasible educational and supportive care intervention for patients with LARS and has the potential to improve patients' quality of life. [ABSTRACT FROM AUTHOR]

The Lasso and Ridge estimators are effective variable selection methods for a simple linear model. While the multiple linear model is often used in practice, only few studies have examined its problem of variable selection. To address this gap, we study such problem by taking advantage of the Lasso and Ridge estimate. We propose two variable selection methods in the multiple linear model and introduce the multiple random simulation (MRS) algorithm, whose efficiency is similar to that of the least angle regression (LARS) algorithm in a simple linear model. We verify the performance of these two algorithms by applying them to real diabetes data and find that the LARS algorithm cannot be easily applied in a multiple linear model. We also illustrate the excellent performance of MRS by applying this algorithm on a simulated dataset. [ABSTRACT FROM AUTHOR]

Purpose: To compare the long-term outcomes of anterior cruciate ligament (ACL) reconstruction using a four-strand hamstring tendon graft alone (hamstring group) or with synthetics (Ligament Augmentation and Reconstruction System, LARS group) or synthetic meshwork of LARS (meshwork group). Methods: Patients who underwent ACL reconstruction using four-strand hamstring tendon grafts (hamstring group), autologous hamstrings augmented with the LARS (LARS group), or synthetic meshwork of LARS (meshwork group) were selected in this prospective randomized clinical study. Patient-reported outcome measures (PROMs) were obtained preoperatively; at 6, 12, and 18 months postoperatively; and at final follow-up between 3 and 8 years. Second-look arthroscopic findings were used to evaluate graft morphology based on graft tension, graft tear, and synovial coverage. Results: A total of 141 consecutive patients underwent ACL reconstruction, 47 patients in each group, and 21 patients were lost to follow-up during the study period. At the 6-month follow-up, the IKDC scores and Lysholm scores were significantly better in the LARS group (P < 0.05). At the 6- and 12-month follow-ups, the KOS-ADLS, KOOS-activities of daily living and quality of life, NSARS scores, GRC scores, Tegner scores, and ACL-RSI scores were significantly better in the LARS group (P < 0.05). For the LARS group, hamstring group, and meshwork group, the cumulative failure rates were 8.5%, 12.8%, and 4.3%, respectively. Malposition of the femoral tunnel was significantly associated with cumulative failure (P < 0.05). There was no difference between the groups in other outcomes at any other time, including radiographic and arthroscopic outcomes. Conclusions: ACL reconstruction using autologous hamstring augmented with LARS resulted in significantly better clinical scores with a faster return to sports and comparative side-to-side differences in graft laxity by 6 and 12 months follow-up. Despite these findings, no statistically significant differences were seen among the three patient groups in terms of objective outcomes and clinical scores at the 18-month, 3-year and 8-year follow-ups. Additionally, a malpositioned femoral tunnel was associated with graft failure. [ABSTRACT FROM AUTHOR]

Aim: Even if a defunctioning stoma mitigates the serious consequences of anastomotic leakage after total mesorectal excision (TME) for rectal cancer, the presence of a temporary stoma or having a stoma for a prolonged period of time may also be a determining factor for further morbidities and poor bowel function. The aim of this study was to evaluate the impact of diverting stomas on clinical and functional outcomes after TME, comparing ileostomy or colostomy effects. Methods: All consecutive patients who underwent TME for rectal cancer between March 2017 and December 2020 in three Italian referral centres were enrolled in the present study. For every patient sex, age, stage of the tumour, neoadjuvant therapy, surgical technique, anastomotic technique, the presence of a diverting stoma, perioperative complications and functional postoperative status were recorded. Considering the diverting stoma, the kind of stoma, length of time before closure and stoma related complications were evaluated. Results: During the study period 416 consecutive patients (63% men) were included. Preoperative neoadjuvant therapy was performed in 79%. A minimally invasive approach was performed in >95% of patients. Temporary stoma was performed during the operation in 387 patients (93%) (ileostomy 71%, colostomy 21%). The stoma was closed in 84% of patients. The median time from surgery to stoma closure was 145 days. No difference was found between ileostomy and colostomy in overall morbidity after stoma creation and closure. Moreover, increased postoperative functional disturbance seemed to be significantly proportional to the attending time for closure for ileostomy. Conclusion: The presence of a defunctioning stoma seems to have a negative impact on functional bowel activity, especially for delayed closure for ileostomy. This should be considered when the kind of stoma (ileostomy vs. colostomy) is selected for each patient. [ABSTRACT FROM AUTHOR]

Abstract Background Shoulder soft tissue function reconstruction during tumor-type hemishoulder replacement is an important step to restore shoulder function. This study evaluates the functional prognosis and postoperative complications of ligament advanced reinforcement system (LARS)-assisted soft tissue functional reconstruction in tumor-type hemi-shoulder replacement. Materials and methods Twenty-two patients with an average age of 37.5 ± 17.8 years diagnosed with benign invasive tumors, primary malignant bone tumors, or bone metastases were enrolled in this study. The patient’s medical records (history and surgical details), histological sections, imaging files, oncological prognosis, functional prognosis, and postoperative complications were collected. The upper limb function and shoulder joint function were evaluated using the Musculoskeletal Tumor Society (MSTS) system and American Shoulder and Elbow Surgeons (ASES) scoring criteria, respectively. Results Twenty-two patients comprising 12 males and 10 females were enrolled. Overall, 9 patients had preoperative pathological fractures. The mean lesion length was 8.6 ± 3.0 cm. The local recurrence was observed in 3 cases, including 2 cases of osteosarcoma and 1 case of MGCT. A further 4 cases had pulmonary metastasis, including 2 cases with local tumor recurrence. The average postoperative MSTS score was 25.8 ± 1.7, and the score of postoperative ASES was 85.7 ± 6.0, both of which showed satisfactory functional recovery. Two cases experienced postoperative complications requiring surgical intervention, including one periprosthetic fracture and one giant cell granuloma. Prosthesis dislocation occurred in 1 case. None of the cases of periprosthetic infection or postoperative complications resulted in implant failure. Conclusions LARS-assisted soft tissue function reconstruction in benign and malignant proximal humerus tumors after a tumor-type hemi-shoulder replacement is an effective technical improvement, which can effectively repair the integrity of the joint capsule to restore joint stability, provide a medium for soft tissue attachment to rebuild the muscular dynamic system, and eliminate residual dead space around the prosthesis, effectively improving limb function and reduce postoperative infection complications.

Abstract Background To compare proprioception recovery after anterior cruciate ligament reconstruction (ACLR) with a hamstring tendon autograft versus the artificial Ligament Advanced Reinforcement System (LARS). Material and methods Forty patients (9 females, 31 males) with anterior cruciate ligament (ACL) rupture were enrolled in this prospective study. Patients were randomized to two groups, 1) ACLR using a hamstring tendon autograft (n = 20) or 2) ACLR using artificial LARS (n = 20). Proprioception was assessed with knee joint position sense (JPS) passive-passive test at 45° and 75° flexions, with the contralateral healthy knee as a control baseline to calculate the JPS error. Knee JPS absolute error was used as the main outcome variable and defined as the absolute difference between the reproduction and target angles. Results JPS error in both groups at 3 months after ACLR was significantly higher than that at 12 months. However, no significant difference in JPS error was detected between the LARS and autograft groups at either 3 or 12 months after ACLR. Analyzing JPS data by grouping patients according to whether ACLR was performed more or less than 1 year following injury regardless of graft type showed a statistically significant difference between the groups at 3 months, but not at 12 months, after ACLR. Patients receiving the graft within 1 year of injury had a lower JPS error than those receiving the graft more than 1 year after injury at 3 months. No complications were associated with either ACLR method. Conclusion ACLR with a hamstring tendon autograft or LARS artificial graft is similarly safe and effective for recovering knee proprioception.

Abstract Background Autologous hamstrings and patellar tendon have historically been considered the gold standard grafts for anterior cruciate ligament reconstruction (ACLR). In the last decades, the utilization of synthetic grafts has re-emerged due to advantageous lack of donor site morbidity and more rapid return to sport. The Ligament Augmentation and Reconstruction System (LARS) has demonstrated to be a valid and safe option for ACLR in the short term. However, recent studies have pointed out the notable frequency of associated complications, including synovitis, mechanical failure, and even chondrolysis requiring joint replacement. Case presentation We report the case of a 23-year-old male who developed a serious foreign body reaction with wide osteolysis of both femoral and tibial tunnels following ACLR with LARS. During first-stage arthroscopy, we performed a debridement of the pseudocystic mass incorporating the anterior cruciate ligament (ACL) and extending towards the tunnels, which were filled with autologous anterior iliac crest bone graft chips. Histological analysis revealed the presence of chronic inflammation, fibrosis, and foreign body giant cells with synthetic fiber inclusions. Furthermore, physicochemical analysis showed signs of fiber depolymerization, increased crystallinity and formation of lipid peroxidation-derived aldehydes, which indicate mechanical aging and instability of the graft. After 8 months, revision surgery was performed and ACL revision surgery with autologous hamstrings was successfully carried out. Conclusions The use of the LARS grafts for ACLR should be cautiously contemplated considering the high risk of complications and early failure.

We propose a novel algorithm to perform efficient modified-Newton-Raphson optimization over the active set of selected features (AMNR), and show that it allows to estimate multiple penalized least-squares (MPLS) models. MPLS models are used to find flexible and adaptive least-squares solutions to highly ill-posed linear inverse problems, mainly requiring them to be simultaneously sparse and smooth. This is relevant for applications where there is no ground truth, e.g., estimating electrophysiological sources. In this work, we step on a modified Newton-Raphson algorithm that can be interpreted as a generalization of the Minorization-Maximization algorithm to include combinations of several constraints, and derive the AMNR algorithm following an approach similar to that used for Least Angle Regression. This algorithm allows us to implement many different MPLS models, including novel models such as the Smooth Nonnegative Garrote and the Nonnegative Smooth LASSO. The performance of the algorithm is evaluated using simulated data from a simple ill-posed linear regression and from a realistic Electroencephalographic setup. Different models containing one or two penalty functions, and including sign constraints were evaluated in both cases. The algorithm allowed the recovering of solutions in a fast way and with adequate quality in simulated scenarios for different n/p ratios. [ABSTRACT FROM AUTHOR]

Purpose: Clinical experience shows complaints similar to LARS not only after rectal surgery, but even after other types of colorectal surgery. Our aim was to investigate the occurrence of LARS after several types of colorectal surgery and its impact on quality of life. Methods: We included adult patients who underwent colorectal surgery at our centre from January 2016 until March 2019, regardless of indication. A questionnaire was sent evaluating LARS and quality of life. Results: The questionnaire was answered by 119 patients. We noticed highest LARS-score after rectum surgery (26.1), but also surprisingly higher LARS-score after right-sided colectomy (21.0) compared to left-sided colectomy (16.4). We report lowest quality of life after rectal surgery, but higher quality of life in left colectomy compared to right colectomy. Conclusion: LARS-score did not significantly correlate with type of procedure; however, higher LARS-scores were noted after right-sided colectomy compared to left-sided colectomy with similar impact on quality of life. We suggest CORS (colorectal resection syndrome) as a more suiting conceptual name instead of LARS to describe functional bowel complaints after colorectal surgery. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the potential benefits associated with the short-term (6 months) treatment with transanal irrigation (TAI) in patients suffering from functional constipation (FC), functional fecal incontinence (FI), and low anterior resection syndrome (LARS). Methods: A multicenter observational study (12 centers; 369 patients) was conducted to assess the following primary and secondary objectives: to evaluate the level of satisfaction regarding bowel control and quality of life (QoL); to evaluate bowel symptoms severity and dropout frequency and reason. To this aim, validated questionnaires were provided to the patients at baseline (T0) and after 6 months of TAI treatment (T6) performed with the medical device Peristeen® Plus (Coloplast A/S, Denmark). Statistical analyses were conducted to compare the outcomes obtained at T0 and T6. Results: A 6-month treatment with TAI enabled a statistically significant (p < 0.05) improvement of QoL scores, satisfaction scores regarding bowel control, and severity indexes of disorder-related symptoms in patients suffering from FC, FI, and LARS. Globally, 8.0% of patients discontinued the treatment after 6 months as a result of occurrence of symptoms (2.4%) or other justifications (3.8%) such as personal reasons. None of the dropouts were due to treatment inefficacy. Conclusion: Results of the present study suggest that short-term TAI treatment is beneficial for patients suffering from functional bowel disorders and LARS. Future analysis of prospective data will focus on the clinical outcomes associated with the long-term use (up to 24 months) of TAI when dealing with these types of medical conditions. [ABSTRACT FROM AUTHOR]

Background: Long-term bowel dysfunction after resection for rectal cancer, known as low anterior resection syndrome (LARS), is observed in many patients. The LARS score was developed to assess this syndrome and its impact on the quality of life in Danish patients. Recently versions in English and many other languages have been validated. The aim of this study was to validate the Turkish translation of the LARS score in patients who have undergone treatment for rectal cancer. Methods: Rectal cancer patients who underwent low anterior resection in May 2000- May 2018 in three Turkish centers received the LARS score questionnaire, the European Organisation for Research and Treatment Of Cancer Core Quality of Life questionnaire [Ed.11] (EORTC QLQ-C30), and a single ad hoc quality of life question. The test–retest reliability of the LARS score was evaluated by asking a randomly selected subgroup of patients to repeat the assessment of the LARS score 2 to 4 weeks after their initial response. Results: A total of 326 patients were reviewed and contacted for the study, and 222 (68%) were eligible for the analyses (129 males, 93 females, median age 64 years [range:24–87 years, IQR = 14]) There was a strong association between the LARS score and quality of life (p < 0.01) and the test–retest reliability was high. The intraclass correlation coefficient was 0.78 (95% CI 0.73–0.83) for the whole study group and 0.79 (95% CI 0.68–0.87) for the subgroup, indicating strong reliability. Conclusions: The Turkish translation of the LARS score has psychometric properties comparable with previously published results in similar studies. The Turkish version of the LARS score can be considered a valid and reliable tool for measuring LARS in Turkish rectal cancer patients. Clinical trial registration: NCT05289531. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the views of people on their healthcare needs when managing their bowel symptoms following an anterior resection. Method: One‐to‐one, semi‐structured interviews were undertaken, after consent and completion of three questionnaires. Results were analysed using a modified framework analysis and presented narratively. Results: Twenty three participants aged 38–75 years were interviewed; 10 were men. Most had low anterior resection syndrome (LARS) scores indicating 'major LARS', Bowel Function Index scores ranged from 28 to 65. The two most bothersome symptoms were faecal incontinence and unpredictable bowel function. Data were grouped into three broad themes: 'treatment consequences', 'strategies and compromises' and 'healthcare needs.' Each theme had four subthemes, such as 'bowel dysfunction' in the theme 'treatment consequences'. Bowel symptoms were common and persistent. Symptom management often required multiple interventions. Expressed healthcare needs included managing expectations through clinician‐led information. Participants needed knowledgeable clinicians to enquire about and assess symptoms, provide and reiterate information as well as making an onward referral to enable symptom management. Peers improved the adaptation process through support and advice. Our findings indicate that participants' needs are not being fully met. Conclusion: People with LARS have unmet healthcare requirements needed to meet their individual goals. We propose these are addressed by using the acronym 'LARS': a Learned clinician who Asks and assesses bowel symptoms, Revisiting the topic to address new or persisting symptoms as well as Signposting, advising or referring onwards as needed. [ABSTRACT FROM AUTHOR]

Abstract Background Osteosarcoma is one of the most malignant tumors, and it occurs mostly in children and adolescents. Currently, surgery and chemotherapy are the main treatments. The recurrence rate is high and the prognosis is often poor. Finding an effective target gene therapy for osteosarcoma may effectively improve its prognosis. Method In this study, genes essential for the survival of osteosarcoma cells were identified by genome-wide screening of CRISPR-Cas9 based on the DepMap database. The expression of these essential genes in osteosarcoma patients’ tissues and normal tissues was identified in the GSE19276 database. Functional pathway enrichment analysis, protein interaction network construction, and LASSO were performed to construct a prognostic risk model based on these essential genes. CCK8 assay was used to detect the effect of essential gene-LARS (Leucyl-TRNA Synthetase 1) on the proliferation of osteosarcoma. Results In this study, 785 genes critical for osteosarcoma cell proliferation were identified from the DepMap. Among these 785 essential genes, 59 DEGs were identified in osteosarcoma tissues. In the functional enrichment analysis, these 59 essential genes were mainly enriched in cell cycle-related signaling pathways. Furthermore, we established a risk score module, including LARS and DNAJC17, screened from these 59 genes, and this module could divide osteosarcoma patients into the low-risk and high-risk groups. In addition, knockdown of LARS expression inhibited the proliferative ability of osteosarcoma cells. A significant correlation was found between LARS expression and Monocytic lineage, T cells, and Fibroblasts. Conclusion In conclusion, LARS was identified as an essential gene for survival in osteosarcoma based on the DepMap database. Knockdown of LARS expression significantly inhibited the proliferation of osteosarcoma cells, suggesting that it is involved in the formation and development of osteosarcoma. The results are useful as a foundation for further studies to elucidate a potential osteosarcoma diagnostic index and therapeutic targets.

Background: Shoulder soft tissue function reconstruction during tumor-type hemishoulder replacement is an important step to restore shoulder function. This study evaluates the functional prognosis and postoperative complications of ligament advanced reinforcement system (LARS)-assisted soft tissue functional reconstruction in tumor-type hemi-shoulder replacement. Materials and methods: Twenty-two patients with an average age of 37.5 ± 17.8 years diagnosed with benign invasive tumors, primary malignant bone tumors, or bone metastases were enrolled in this study. The patient's medical records (history and surgical details), histological sections, imaging files, oncological prognosis, functional prognosis, and postoperative complications were collected. The upper limb function and shoulder joint function were evaluated using the Musculoskeletal Tumor Society (MSTS) system and American Shoulder and Elbow Surgeons (ASES) scoring criteria, respectively. Results: Twenty-two patients comprising 12 males and 10 females were enrolled. Overall, 9 patients had preoperative pathological fractures. The mean lesion length was 8.6 ± 3.0 cm. The local recurrence was observed in 3 cases, including 2 cases of osteosarcoma and 1 case of MGCT. A further 4 cases had pulmonary metastasis, including 2 cases with local tumor recurrence. The average postoperative MSTS score was 25.8 ± 1.7, and the score of postoperative ASES was 85.7 ± 6.0, both of which showed satisfactory functional recovery. Two cases experienced postoperative complications requiring surgical intervention, including one periprosthetic fracture and one giant cell granuloma. Prosthesis dislocation occurred in 1 case. None of the cases of periprosthetic infection or postoperative complications resulted in implant failure. Conclusions: LARS-assisted soft tissue function reconstruction in benign and malignant proximal humerus tumors after a tumor-type hemi-shoulder replacement is an effective technical improvement, which can effectively repair the integrity of the joint capsule to restore joint stability, provide a medium for soft tissue attachment to rebuild the muscular dynamic system, and eliminate residual dead space around the prosthesis, effectively improving limb function and reduce postoperative infection complications. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim was to explore the information and counselling needs of rectal cancer survivors confronted with major low anterior resection syndrome. Background: Rectal cancer survivors are often confronted with bowel problems after surgery. This is called low anterior resection syndrome. Patients are unsure what to expect after treatment and healthcare professionals often underestimate the impact of low anterior resection syndrome on patients' lives. Design: A qualitative study with a grounded theory approach was conducted. Methods: Patients were recruited between 2017 and 2019 in three hospitals, and a call was distributed in two patients' organisations. Semi‐structured interviews with patients confronted with major low anterior resection syndrome were performed. An iterative process between data collection and data analysis was used. Data analysis was done using the constant comparative method, and investigators' triangulation was applied. Qualitative data were reported following COREQ guidelines. The study was registered at Clinicaltrials.gov NCT04896879. Results: A total of 28 patients were interviewed until theoretical data saturation. Before surgery patients' need for information varied according to their individual coping mechanisms. Some patients required information before surgery, while others considered this too overwhelming. When confronted with LARS, patients desired that healthcare professionals recognised its impact and clarified its expected evolution. A proactive counselling with an easy accessible and approachable healthcare professional was beneficial. Conclusion: Patients expressed several needs regarding the information before rectal cancer surgery and counselling of low anterior resection syndrome after surgery. Relevance to clinical practice: Better knowledge and understanding of major low anterior resection syndrome and its challenges by healthcare professionals are crucial. Especially the impact on quality of life is significant for patients and underestimated by healthcare professionals. Information before surgery and counselling when confronted with major low anterior resection syndrome should be optimised and tailored to patients' needs. [ABSTRACT FROM AUTHOR]

The incidence of long-term complications after rectal surgery varies widely among studies, and data regarding functional sequelae after transanal surgery are lacking. The aim of this study is to describe the incidence and change over time of sexual, urinary, and intestinal dysfunction in a single-center cohort, identifying independent predictors of dysfunction. A retrospective analysis of all rectal resections performed between March 2016 and March 2020 at our institution was conducted. Validated questionnaires were administered to assess post-operative function. Predictors of dysfunction were assessed by univariate and multivariate analysis. Latent class analysis was used to distinguish different risk profile classes. One hundred and forty-five patients were included. Sexual dysfunction at 1 month rose to 37% for both sexes, whereas urinary dysfunction reached 34% in males only. A significant (p < 0.05) improvement in urogenital function was observed between 1 and 6 months only. Intestinal dysfunction increased at 1 month, with no significant improvement between 1 and 12 months. Independent predictors of genitourinary dysfunction were post-operative urinary retention, pelvic collection, and Clavien–Dindo score ≥ III (p < 0.05). Transanal surgery resulted an independent predictor of better function (p < 0.05). Transanal approach, Clavien–Dindo score ≥ III, and anastomotic stenosis were independent predictors of higher LARS scores (p < 0.05). Maximum dysfunction was found at 1 month after surgery. Improvement was earlier for sexual and urinary dysfunction, whereas intestinal dysfunction improved slower and depended on pelvic floor rehabilitation. Transanal approach was protective for urinary and sexual function, although associated with a higher LARS score. Prevention of anastomosis-related complications resulted protective of post-operative function. [ABSTRACT FROM AUTHOR]

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Introduction: Radical rectal cancer resection can lead to a long-term bowel function impairment known as low anterior resection syndrome (LARS). It remains unclear how to determine which patients are at a higher risk of developing LARS post-surgery. The POLARS tool was designed to predict the onset and severity of LARS in rectal cancer patients after surgery. The study aimed to assess the accuracy of POLARS in predicting the onset of LARS. Material and methods: A total of 66 rectal cancer patients treated laparoscopically between January 2016 and December 2017 were included in this retrospective study. Using POLARS, the predictive value for the occurrence of LARS was documented. During an average 17-month follow-up period, the bowel function of the patients was assessed using the dedicated LARS questionnaire. The predicted and actual scores were then compared. Results: Study participants included 36 women (54.5%) and 30 men (45.5%), with a mean age of 62.55 years (standard deviation: 10.2; range: 37-81). The mean predicted score according to POLARS was 24.5 (i.e. category "minor LARS"), and the mean actual score in the follow-up period was 16.42 ("no LARS" category). In only 39% of patients, the predicted LARS category was the same as the actual LARS category assessed by the questionnaire. Worse bowel function than reported at follow-up was predicted in 75% of all mispredictions. Conclusions: POLARS did not prove to be accurate in predicting the risk and severity of LARS in these patients, although the average numbers appear promising. Further evaluation of the POLARS tool using a larger cohort is needed. [ABSTRACT FROM AUTHOR]

Abstract Background Osteopetrosis is an uncommon inherited disease marked with elevated bone density and frequent bone fractures owing to flawed osteoclast activity. Autosomal dominant osteopetrosis type 2 (ADO-2), a benign form of osteopetrosis, is also known as Albers-Schonberg disease. Case presentation We report the first successful anterior cruciate ligament (ACL) reconstruction surgery for ACL rupture treatment in a 30-year-old female with ADO-2, who carried a heterozygous missense mutation c.2227C > T (p.Arg743Trp) in exon 23 of the chloride channel 7 (CLCN7) gene. Histopathological analysis of the ruptured ACL sample revealed massive calcium salt deposition in the ligament tissue. A ligament advanced reinforcement system (LARS) artificial ligament was employed in her ACL reconstruction surgery. At her final 16 month’s follow-up, she reported no knee instability symptoms and other complications. The range of motion of the affected knee was good. The side-to-side difference in knee laxity, as evidenced by a KT-1000 arthrometer was 0.9 mm. The Lysholm score improved from 45 before operation to 83 after operation. The Tegner activity score improved from 1 before operation to 4 after operation. Conclusions Our findings further confirmed that the newly identified mutated locus (p.Arg743Trp) may lead to acid secretion disorders at different sites (including calcified ACL in our case). In terms of clinical treatment, ligament reconstruction surgery in patients with Albers-Schonberg disease presents a unique challenge to orthopedic surgeons and requires further preparation and time.

The Least Absolute Shrinkage and Selection Operator (LASSO) is used to tackle both the multicollinearity issue and the variable selection concurrently in the linear regression model. The Least Angle Regression (LARS) algorithm has been used widely to produce LASSO solutions. However, this algorithm is unreliable when high multicollinearity exists among regressor variables. One solution to improve the estimation of regression parameters when multicollinearity exists is adding preliminary information about the regression coefficient to the model as either exact linear restrictions or stochastic linear restrictions. Based on this solution, this article proposed a generalized version of the stochastic restricted LARS algorithm, which combines LASSO with existing stochastic restricted estimators. Further, we examined the performance of the proposed algorithm by employing a Monte Carlo simulation study and a numerical example.

Abstract Background Low anterior resection syndrome (LARS) is the most common complication after rectal cancer resection. We aimed to identify LARS' predictive factors and construct and evaluate a predictive model for LARS. Methods This retrospective study included patients with rectal cancer more than 1 year after laparoscopic or robotic-assisted surgery. We administered a questionnaire to evaluate the degree of LARS. In addition, we examined clinical characteristics with univariate and multivariate analysis to identify predictive factors for major LARS. Finally, we divided the obtained data into a learning set and a validation set. We constructed a predictive model for major LARS using the learning set and assessed the predictive accuracy of the validation set. Results We reviewed 160 patients with rectal cancer and divided them into a learning set (n = 115) and a validation set (n = 45). Univariate and multivariate analyses in the learning set showed that male (odds ratio [OR]: 2.88, 95% confidence interval [95%CI] 1.11–8.09, p = 0.03), age

Background: There is a relative shortage of studies directly addressing the postoperative rectal cancer patients’ evacuatory dysfunction, as estimated by the low anterior resection syndrome (LARS) score at repeated assessment time-points. The aim of the present study was to prospectively evaluate the incidence of LARS at predefined time intervals during the first 3 years after sphincter preserving rectal cancer surgery and to enlighten the effect of identified risk factors. Materials and methods: Seventy-eight patients, who remained alive and recurrence-free 2 years after (ultra-) low anterior resection were prospectively assessed at 6, 12, 18, 24, 30 and 36 months postoperatively, using the LARS score as bowel dysfunction outcome measure. All patients have completed the 2-year follow-up functional assessment, while 56 and 37 of them have been evaluated up to the 30th and the 36th postoperative month, respectively. Results: The proportion of patients with “major and minor” LARS significantly decreased during the first 3 evaluations (up to 18 months) (74% vs 62% vs 35%, p = 0.0001). The tumor distance from the anal verge and the neoadjuvant radiotherapy were identified as risk factors for high LARS score at 6 months (p

Background: There are many reconstruction methods after sternal tumor resection, but the method that LARS mesh combines with bone-cement has not been reported.Case report: A 54-year-old female patient and a 55-year-old male patient admitted to our department all presented with sternum masses, but neither presented with respiratory disorders. In women with limited manubrium sternum lesions, we resected the manubrium sternum completely. In men with sternal lesions, we removed part of the sternum and part of the sternocostal joint. The patients recovered well after surgery, and there were no respiratory complications and no tumor recurrence during the 1-year follow-up respectively.Conclusion: We report two cases of sternal defect repair using LARS mesh combined with bone cement. This method is safe and stable, and can achieve satisfactory results.

Purpose: To compare the clinical, radiological, and second-look arthroscopic outcomes in patients who underwent anterior cruciate ligament (ACL) reconstruction using a four-strand hamstring tendon graft (hamstring group) either without augmentation or with ligament augmentation and reconstruction system (LARS) augmentation (LARS augmentation group). Methods: From January 2018 to December 2019, patients who underwent ACL reconstruction were included. Patient-reported outcome measures (PROMs) were undertaken pre-operatively and at three, six, 12, and 24 months post-operatively. Arthroscopic evaluation was performed focusing on the morphology of the graft based on graft tension, graft tear, and synovial coverage. Results: A total of 178 consecutive patients received single-bundle ACL reconstruction, 89 patients in each group, and 20 patients were lost to follow-up in the first two years. At the three month follow-up, the LARS augmentation group had significantly higher Lysholm scores, IKDC scores, and KOS-ADLS scores than the hamstring group (P < 0.001). At the three, six and 12-month follow-ups, there were significantly higher Tegner scores and ACL-RSI scores in the LARS augmentation group than in the hamstring group (P < 0.05). At the three and six month follow-ups, the LARS augmentation group had significantly higher rates of return to sports and return to sports at their preinjury level (P < 0.05). There were no between-group differences in other outcomes, including arthroscopic outcomes, graft signal intensity, post-operative complications or rerupture rates. Conclusions: Autologous hamstring augmented with the LARS augmentation technique provides good and realistic clinical and functional results during the early post-operative period with high levels of satisfaction of patients, including participation in sports and physical activity, and high rates of return to sports at the preinjury level, without any apparent complications compared with hamstring ACL reconstruction alone. No increases in complication, reinjury rates, or increased lateral laxity were observed at the 12-month or 24-month follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Sigmoid resection for diverticular disease is a frequent surgical procedure in the Western world. However, long-term bowel function after sigmoid resection has been poorly described in the literature. This study aims to assess the long-term bowel function after tubular sigmoid resection with preservation of inferior mesenteric artery (IMA) for diverticular disease. Methods: We retrospectively identified patients who underwent sigmoid resection for diverticular disease between 2002 and 2012 at a tertiary referral center in northern Germany. Using well-validated questionnaires, bowel function was assessed for fecal urgency, incontinence, and obstructed defecation. The presence of bowel dysfunction was compared to baseline characteristics and perioperative outcome. Results: Two hundred and thirty-eight patients with a mean age of 59.2 ± 10 years responded to our survey. The follow-up was conducted 117 ± 32 months after surgery. At follow-up, 44 patients (18.5%) had minor LARS (LARS 21–29) and 35 (15.1%) major LARS (LARS ≥ 30–42), 35 patients had moderate-severe incontinence (CCIS ≥ 7), and 2 patients (1%) had overt obstipation (CCOS ≥ 15). The multivariate analysis showed that female gender was the only prognostic factor for long-term incontinence (CCIS ≥ 7), and ASA score was the only preoperative prognostic factor for the presence of major LARS at follow-up. Conclusion: Sigmoid resection for diverticular disease can be associated with long-term bowel dysfunction, even with tubular dissection and preservation of IMA. These findings suggest intercolonic mechanisms of developing symptoms of bowel dysfunction after disruption of the colorectal continuity that are so far summarized as “sigmoidectomy syndrome.” [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate transanal irrigation (TAI) as a treatment for low anterior resection syndrome (LARS). Background: LARS is a bowel disorder that is common after sphincter preserving rectal cancer surgery. Despite symptomatic medical treatment of LARS many patients still experience bowel symptoms that may have a negative impact on quality of life (QoL). TAI is a treatment strategy, of which the clinical experience is promising but scientific evidence is limited. Materials and Methods: A multicenter randomized trial comparing TAI (intervention) with conservative treatment (control) was performed. Inclusion criteria were major LARS, age above 18 years, low anterior resection with anastomosis and a defunctioning stoma as primary surgery, >6 months since stoma reversal, anastomosis without signs of leakage or stricture, and no signs of recurrence at 1-year follow-up. The primary endpoint was differences in bowel function at 12-month follow-up measured by LARS score, Cleveland Clinic Florida Fecal Incontinence Score, and 4 study-specific questions. The secondary outcome was QoL. Results: A total of 45 patients were included, 22 in the TAI group and 23 in the control group. Follow-up was available for 16 and 22 patients, respectively. At 12 months, patients in the TAI group reported significantly lower LARS scores (22.9 vs 32.4; P =0.002) and Cleveland Clinic Florida Fecal Incontinence Score (6.4 vs 9.2; P =0.050). In addition, patients in the TAI group also scored significantly higher QoL [8 of 16 European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) QoL aspects] compared with the control group. Conclusions: The results confirm our clinical experience that TAI reduces symptoms included in LARS and improves QoL. [ABSTRACT FROM AUTHOR]