Search

The diffusion tensor imaging (DTI) parameters (fractional anisotropy [FA] and apparent diffusion coefficient [ADC]) are commonly used to provide quantitative information on tissues. This study aimed to evaluate the predictive value of preoperative DTI of the spinal nerve roots in the surgical outcome of lumbar disc herniation (LDH).A total of 117 LDH patients were included. According to the postoperative improvement rate, the patients were dichotomized into the unfavouratble group (n=35) and favourable group (n=82).The favourable group had a younger age (p=0.005) and a shorter disease course (P0.001) than the unfavourable group. The favourable group had higher affected side FA and ADC and lower healthy/affected FA and ADC ratio than the unfavourable group (all P0.05). Logistic regression analysis showed that younger age, shorter disease course, higher affected side FA and ADC, lower healthy/affected FA and ADC ratio, and lower healthy side ADC were the independent factors associated with positive surgical outcome. ROC analysis showed that the affected side FA had an excellent predictive performance for the surgical outcome (AUC=0.900). The Healthy/affected FA ratio had a good predictive performance (AUC=0.846). The overall predictive accuracy ranged from 0.91 to 0.92. However, ADC had poor predictive performance (AUC ranged from 0.626 to 0.663).These results suggested the preoperative affected side FA value had an excellent predictive performance for the surgical outcome of LDH patients. The LDH patients with a higher preoperative affected side FA value were more likely to have a positive surgical outcome.

AIMS To compare efficacy and safety between neurogenic and non-neurogenic women after adjustable continence therapy (ACT®) balloons implantation to treat stress urinary incontinence (SUI) due to intrinsic sphincter deficiency. METHODS In the present retrospective multicentric study, all neurogenic and non-neurogenic women implanted with ACT® balloons between 2000 and 2018 were considered for inclusion. Efficacy was compared 1 year after implantation, and women were allocated in three different groups as follows. Success: maximum 1 pad per day and patient's impression of improvement assessed using a numeral rating scale (NRS) ≥8/10. Improvement: decrease of daily pad use and/or NRS ≥5/10. Failure: increase or stability of daily pad use or NRS

Background Barbed polydioxanone (PDO) sutures allowing for minimally invasive skin lifting are broadly and increasingly used in aesthetic dermatology. Objectives To describe utilization of diverse barbed PDO sutures for aesthetic facial corrections in Caucasian patients, to evaluate long-term safety and to demonstrate effectiveness in skin tightening, redefinition of facial contours, and tissue elevation. Methods A retrospective chart review of patients routinely treated with barbed PDO sutures on face was performed. Aesthetic improvement was evaluated at 6-, 12- and 24-week posttreatment by the treating physician, patients, and an independent photographic reviewer. Patient’s satisfaction with treatment outcome was evaluated. Procedure effects were also objectively measured by markerless tracking analysis. Results Sixty patients were treated with a total of 388 barbed sutures in various anatomical areas and followed-up for 24 weeks. At Week 24, the aesthetic improvement rate was 80% to 100% (depending on the evaluator), skin movements related to pre-treatment photographs showed significant changes across several different anatomical regions, and 97% of patients were satisfied with the overall treatment outcome. Transient, mild, and short-lasting adverse events, mostly pain and hematoma, occurred in 15% of patients. Conclusions Barbed PDO sutures are safe and highly effective for aesthetic corrections, with results lasting for at least 24 weeks. Level of Evidence: 4

To evaluate the efficacy and safety of laser alone therapy and laser combination therapy (mainly combined with other kinds of laser or steroids) for keloid. PubMed, Embase and Web of Science were searched for relevant articles from inception to June 2020. Comprehensive Meta-Analysis software 2.0 (CMA) was used to perform the meta-analysis. A total of 29 articles were included in this meta-analysis. During the mean follow-up of 14 (1–84) months, the overall improvement rates of baseline Vancouver scar scale (VSS) score and itch were 0.454 (95%CI 0.351–0.561, I2 = 0) and 0.786 (95%CI 0.613–0.895, I2 = 0) in the laser combination therapy group. The improvement rates of scar height and flexibility in the laser combination therapy group were 0.629 (95%CI 0.519–0.727, I2 = 52.089) and 0.784 (95%CI 0.251–0.975, I2 = 89.420). The average improvement rate of the scar score in laser combination therapy was 0.338 (0.201–0.510); however, there were insufficient data for laser alone therapy comparison. The laser combination therapy had a greater pain improvement rate, 0.580 (0.389–0.750) versus 0.420 (0.224–0.645), compared to laser alone therapy, and a greater degree of good or excellent (> 50%) improvement in the overall scar, 0.636 (95%CI 0.347–0.852) versus 0.149 (95%CI 0.032–0.482), with laser alone therapy. Moreover, a lower regrowth rate of 0.187 (0.129–0.263) versus 0.249 (0.060–0.631), a lower post-treatment pigmentation rate of 0.125 (0.091–0.169) versus 0.135 (0.058–0.282), and a lower infection rate of 0.047 (0.009–0.209) versus 0.076 (0.012–0.351) were observed in the laser combination therapy compared with those rates in the laser alone therapy. The overall effect of laser combination therapy was better than that of laser alone therapy, and the incidence of adverse reactions was lower in laser combination therapy than in laser alone therapy.

INTRODUCTION The use of mesh for vaginal repairs is currently problematic and as a consequence, there is increased interest in native tissue repair. We describe the follow-up data of a sub-analysis of a prospective and multi-center study focusing on the combination of pectopexy and native tissue repair. Patients were followed up for 12-18 months after surgery (+ SD: 15). Two-hundred and sixty-four patients attended the clinics for physical examination and were integrated into the follow-up. Cystocele repair was performed laparoscopically in 84 patients and vaginally in 52 patients. Posterior repair was performed vaginally in 40 patients and laparoscopically in 53 patients. Results: Clinical success rate, patient recommendations and patient satisfaction rates were similar in both groups. The laparoscopic anterior repair resulted in an 89% cure or anatomical improvement rate; this compared to 94.2% for the vaginal approach. In the posterior group, laparoscopy resulted in a 94.3% cure or improvement rate compared to 97.5% in the second group. Conclusions: The outcomes of both strategies showed satisfactory results in our study. Consequently, surgeons may choose between the two strategies according to their preference and skill. The two approaches only differed with regard to vaginal scarring. We suggest future research investigating the long-term impact of scarring.

Chieh-Chen Huang, Haw-Yueh Thong Department of Dermatology, Shin Kong Wu Ho Su Memorial Hospital, Taipei, TaiwanCorrespondence: Haw-Yueh ThongDepartment of Dermatology, Shin Kong Wu Ho Su Memorial Hospital, No. 95, Wenchang Road, Shilin Dist., Taipei City, 111045, Taiwan (R.O.C.)Tel +886-926-612-880Email drkellytang@gmail.comObjective: There are several clinical cases on the application of PRP (platelet-rich plasma) therapies. To improve disadvantages such as the inability to be standardized and stored long term, we proposed a novel platelet-lyophilized treatment (PLT) to enhance the wound healing rate and improve acne scarring.Study Design: A single-blinded study at a single health care center was performed. All subjects were treated with a fractional carbon dioxide laser. On the right side of the face, 2 mL PLT solution (dissolved in normal saline) was applied, while on the left side of the face (control group), 2 mL normal saline was applied. The treatment described above was repeated every 3 to 4 weeks, and 4 treatments were performed in total. Assessments were performed prior to each treatment and at the one-month follow-up after the fourth treatment. Subjective assessments included questionnaires administered by the principal investigator and a self-assessment questionnaire completed by the subjects. Moreover, VISIA complexion analysis was used for objective data collection, and spots, wrinkles, texture, pores, UV spots, brown spots, red areas, and porphyrins were objectively analyzed.Results: Our data indicated that the PLT side showed a more rapid recovery than the saline side; on average, the sloughing off of the crusts was noted on day 5 and day 6. The improvement rate for skin spots, texture, and pores was significantly increased on the PLT side, with the pigment and pore size both having a statistically significant improvement of p< 0.001, while the texture had a significant improvement of p< 0.01.Conclusion: The results suggested that the application of PLT could be a novel method to enhance wound healing and improve acne scarring after laser skin rejuvenation.Keywords: platelet-lyophilized treatment, PLT, wound healing, acne scars, ablative fractional carbon dioxide laser

The purpose of this study was to evaluate the relationship between the correction rate in Cobb angle and the improvement in quality of life profile in terms of Scoliosis Research Society (SRS)-22 values.Between January 2007 and December 2013, posterior instrumentation and fusion was performed to 30 patients with adolescent idiopathic scoliosis (AIS). Patients were grouped according to their improvement rate in Cobb angles after surgery. Patients with an improvement rate of 80% were grouped as Group A; those with an improvement rate of 60% and ≤ 80% as Group B and those with an improvement rate of ≤ 60% were grouped as Group C. The SRS-22 questionnaire of these three groups was calculated and their relationship with the improvement in Cobb angle was evaluated.No statistical difference was found among the three groups in terms of pain, appearance, function, spirit, satisfaction, and SRS-22 values (all p 0.05).The results of this study demonstrate that the degree of correction rate does not correlate with the degree of improvement in the SRS-22 questionnaire in patients with AIS that underwent posterior fusion and instrumentation.Das Ziel dieser Studie ist es, die Beziehung zwischen der Korrekturrate im Cobb-Winkel und der Verbesserung des Lebensqualitätsprofils in Bezug auf SRS-22-Werte (SRS: Scoliosis Research Society) zu bewerten.Dorsale Instrumentierung und Fusion wurden im Zeitraum von Januar 2007 bis Dezember 2013 bei 30 Patienten mit adoleszenter idiopathischer Skoliose (AIS) durchgeführt. Die Patienten wurden nach ihrer Verbesserungsrate im Cobb-Winkel nach der Operation gruppiert. Patienten mit einer Verbesserungsrate von 80% wurden als Gruppe A, diejenigen mit einer Rate von 60% und ≤ 80% wurden als Gruppe B und diejenigen mit einer Rate von ≤ 60% wurden als Gruppe C gruppiert. Der SRS-22-Fragebogen dieser 3 Gruppen wurde berechnet und der jeweilige Zusammenhang mit der Verbesserung des Cobb-Winkels bewertet.Es wurde kein statistischer Unterschied zwischen den Gruppen in Bezug auf Schmerz, Aussehen, Funktion, psychische Verfassung, Zufriedenheit und SRS-22-Werte gefunden (p 0,005).Die Ergebnisse dieser Studie zeigen, dass bei Patienten mit AIS, die einer dorsalen Fusion und Instrumentierung unterzogen wurden, der Grad der Korrekturrate mit dem Grad der Verbesserung des SRS-22-Wertes nicht korreliert.

Background In several previous studies, Charlson comorbidity index (CCI) score was associated with postoperative complications, mortality, and re-admission. There are few reports about the influence of CCI score on postoperative clinical outcome. The purpose of this study was to investigate the influence of comorbidities as calculated with CCI on postoperative clinical outcomes after PLIF. Methods Three hundred sixty-six patients who underwent an elective primary single-level PLIF were included. Postoperative clinical outcome was evaluated with the Japanese Orthopaedic Association lumbar score (JOA score). The correlation coefficient between the CCI score and postoperative improvement in JOA score was investigated. Patients were divided into three groups according to their CCI score (0, 1, and 2+). JOA improvement rate, length of stay (LOS), and direct cost were compared between each group. Postoperative complications were also investigated. Results There was a weak negative relationship between CCI score and JOA improvement rate (r = − 0.20). LOS and direct cost had almost no correlation with CCI score. The JOA improvement rate of group 0 and group 1 was significantly higher than group 2+. LOS and direct cost were also significantly different between group 0 and group 2+. There were 14 postoperative complications. Adverse postoperative complications were equivalently distributed in each group, and not associated with the number of comorbidities. Conclusions A higher CCI score leads to a poor postoperative outcome. The recovery rate of patients with two or more comorbidities was significantly higher than in patients without comorbidities. However, the CCI score did not influence LOS and increased direct costs. The surgeon must take into consideration the patient’s comorbidities when planning a surgical intervention in order to achieve a good clinical outcome.

The topical antifungal efinaconazole was applied to 27 nails (17 patients), and the treatment effects were monitored over a stipulated period (after 3, 6, and 12 months). Fourteen nails were observed for 18 months. Effects of the treatment were determined on the basis of the improvement rate of the turbidity ratio compared with that before treatment. After 12 months, five nails were cured and marked improvement was noted, whereas moderate and marked improvements were noted in 11 and six nails, respectively. The cured patients exhibited a significantly better improvement rate at 6 months (68.8%) than the other groups. Only 10.6% improvement was observed at the same point in time for the mild improvement group. Thus, in cases where the improvement rate after 6 months of treatment was 10% or less, it was judged that oral treatment should be considered. Furthermore, of the nails monitored for 18 months, those that exhibited further growth in improvement rates at 12 months was 51.6%, suggesting that an improvement rate of 50% at 12 months after starting treatment could be used as an indicator to determine switching to oral treatment.

To review available evidence to assess the efficacy and safety of thrombolysis therapy for non-cirrhosis-related portal vein thrombosis (PVT) that has not improved with anti-coagulation. A literature search of databases MEDLINE, EMBASE, PUBMED, Cochrane and World Wide Web identified studies after 2000 utilizing portal vein thrombolysis in non-cirrhotic patients, with a minimum of 5 patients. Nine studies met criteria with 134 patients. The primary outcome evaluated was radiological re-canalization of the portal vein and symptomatic improvement post treatment. Secondary data points obtained included morbidity, mortality, thrombolysis approach and technique. The re-canalization rate following thrombolysis was 84% (0.67–1.02 CI 95%) and the symptomatic improvement rate 86% (0.70–1.01 CI 95%). The major complication rate was 7% (0.01–0.14 CI 95%) and the overall complication rate 25% (0.08–0.41 CI 95%). The direct and systemic thrombolysis approach showed no significant re-canalization rates with an odds ratio of 0.78 (0.24–2.55 CI 95%, P = 0.68). Thrombectomy in conjunction with thrombolysis demonstrated no improved patency or symptom relief with an odds ratio of 1 (0.17–6.03 CI 95%, P = 1.00). Thrombolysis is an effective and safe therapy for portal vein thrombosis in non-cirrhotic patients where systemic anti-coagulation has failed. The heterogenicity of study thrombolysis protocols limits the evaluation of secondary outcomes, and future data should be standardized to determine the role of the thrombolysis access route and thrombectomy.

Polypropylene; Polyvinylidene fluoride; Stress urinary incontinence Polipropileno; Fluoruro de polivinilideno; Incontinencia urinaria de esfuerzo Polipropilè; Fluorur de polivinilidè; Incontinència urinària d'esforç Aims: To compare the effectiveness and safety of polypropylene (PP) and polyvinylidene fluoride (PVDF) transobturator tapes (TOT) for the treatment of female stress urinary incontinence (SUI). Methods: This is a multicentre randomized trial. Women with SUI or stress-predominant mixed urinary incontinence and scheduled for a TOT procedure were randomized to PP or PVDF slings. The primary outcome was 1-year cure or improvement rate using composite criteria. Complications were also compared. Relationships with outcomes were analyzed using multivariable logistic regressions models. Results: From April 2016 to January 2018 285 participants were randomized. PP and PVDF slings showed similar high cure or improvement rate (91.0% vs. 95.6%, p = .138). Improvement in validated questionnaires was also similar. PVDF slings were associated with a lower rate of de novo urgency incontinence (adjusted odds ratio = 0.35; 95% confidence interval = 0.15-0.80). We found no statistical differences in complications rates, although a higher incidence of long-term pain events were observed in the PP group. The study is underpowered to find differences in specific complications owing to the low number of events. Conclusion: PP and PVDF TOTs are equally effective, although PVDF is associated with fewer cases of de novo urgency incontinence. Further studies are needed to give robust conclusions on safety profiles.

The aim was to evaluate the reoperation rate and outcomes in women who underwent transvaginal non-absorbable monofilament polypropylene mesh placement for the treatment of cystocele. The retrospective cohort study included 63 patients who underwent transvaginal surgery using a synthetic polypropylene mesh (Gynemesh™) for cystocele. Patients were evaluated using a clinical examination (POP-Q) and validated questionnaires (PGI-I, PFDI-20, PFIQ-7) at 18 years of follow-up (median 18 years [IQR 16–19]). Cumulative death rate was 13 out of 63 (20%) and rate of total loss to follow-up was 21 out of 50 (42%). Finally, among the 63 women who underwent surgery, 29 completed maximum follow-up and 21 underwent a clinical examination. The cumulative reoperation rate was 35% (22 out of 63). Three patients were reoperated on because of recurrence of pelvic organ prolapse. Among the 63 patients initially operated, vaginal mesh exposure occurred in 16 (25%) during follow-up and 11 women (17%) needed a reintervention for vaginal mesh exposure. One patient was reoperated on for bladder mesh exposure. Among the 29 women who completed follow-up, the overall postoperative improvement rate was 93% after 18 years (PGI-I: 1–3). Mean overall satisfaction rate was 80 out of 100. Functional success rate was 76% (22 out of 29) and anatomical success rate was 62% (13 out of 21). The median score of the POP-DI-6 was 4.1 (IQR: 0–11) and the median score of the PFDI-20 was 30.7 (IQR: 13–60) in the 29 women who completed maximum follow-up. At very long-term follow-up, the recurrence rate of cystocele following polypropylene mesh placement by the vaginal route remained low and the satisfaction rate was high. However, we found high cumulative reoperation and mesh exposure rates.

This study aimed to analyze the effectiveness and safety of ablative fractional carbon dioxide laser systems (CO2 AFL) combined with autologous platelet-rich plasma (PRP) in the treatment of acne scars through the retrieval and collection of related literature to further guide the treatment of acne scars. We searched Web of Science, PubMed, Embase, Wanfang Data, Chinese National Knowledge Infrastructure, and VIP Database. All randomized and nonrandomized controlled trials on CO2 AFL combined with PRP in the treatment of acne scars were included, and Revman5.3 systematic review software was used in the meta-analysis. Nine studies were included in this meta-analysis. The data analysis results showed that the CO2 AFL combined with PRP treatment group showed significantly better results than the pure CO2 AFL control group in terms of clinical improvement score, clinical improvement rate, patient satisfaction, and crusting period. The results of this meta-analysis showed that CO2 AFL combined with PRP in the treatment of acne scars is more effective and safer than CO2 AFL alone.

Treatment of cutaneous leishmaniasis (CL) continues to be a health concern, and alternative therapies with fewer side effects are substantially needed. This study aimed to determine the efficacy of intense pulsed light (IPL) with wavelength spectrum affecting vascular lesions on acute cutaneous leishmaniasis. In this randomized clinical trial study, 30 patients with acute CL were enrolled. Baseline clinical and demographic data were recorded in the checklist after obtaining written informed consent. Patients were randomly allocated to receive either IPL fortnightly (intervention group) or intralesional meglumine antimoniate (MA) weekly (control group) over 10 weeks. Patients were assessed every 2 weeks to determine the size of induration and improvement rate of lesions. Follow-up visits were arranged at 3rd and 6th months. Overall, 15 patients (21 lesions) in the intervention group and 15 patients (22 lesions) in the control group were studied. The size of lesions in the control group was significantly higher at the baseline (P = 0.014) and the second week (P = 0.034), and significantly lower in the eighth week (P = 0.009), compared with the intervention group. The size of lesions in the control group changed during the study (P

Background The diagnosis and treatment of partial-thickness rotator cuff tears remain controversial, and only a few studies have carried out clinical evaluation and comparison based on different types of tears. The aim of this study was to compare the clinical outcomes of arthroscopic cuff repairs using the suture bridge technique in patients with articular partial-thickness rotator cuff tears (APRCTs) vs. those with bursal partial-thickness rotator cuff tears (BPRCTs). Methods We retrospectively evaluated 29 patients with APRCTs and 22 patients with BPRCTs who underwent arthroscopic cuff repair using the suture bridge technique with a minimum 2-year follow-up. Clinical outcomes were evaluated preoperatively and postoperatively using the visual analog scale score, Japanese Orthopaedic Association (JOA) score, Constant score (CS), active range of motion (ROM) of shoulder flexion and abduction, improvement rate for each score, and retear rate. Results The APRCT group had more women, fewer cases of subacromial decompression, and more patients whose condition changed intraoperatively and transitioned into a complete tear. Preoperatively, the JOA score, CS, ROM of shoulder flexion, ROM of shoulder abduction, and external shoulder rotation strength were lower in the APRCT group. Postoperatively, all scores improved significantly in both groups, and the JOA score, CS, and external shoulder rotation strength remained significantly lower in the APRCT group. Improvement and retear rates were not significantly different between the groups. Conclusions The suture bridge technique significantly improved the clinical outcomes of patients with APRCTs and BPRCTs. Preoperative and postoperative functional parameters were worse in APRCT patients.

BACKGROUND AND OBJECTIVES Despite the evident clinical, neurological, orthopedic, and urodynamic dysfunctions, neuroanatomic imaging is normal in patients with occult tethered cord syndrome (OTCS). Therefore, the diagnosis of OTCS can be very complex. In this regard, this systematic review aimed to determine the main clinical features (i.e. neurological, musculoskeletal, and urological abnormalities) and improvement rates of these symptoms in patients with OTCS after the section of the filum terminale (SFT). MATERIALS AND METHODS All the papers published in three electronic databases, namely Google Scholar, PubMed, and Web of Science, were searched for the purposes of this study. The searching process started on 15 October and lasted until 9 November 2020. Eventually, 10 reports were found about the clinical outcomes of SFT for the management of the OTCS. RESULTS The included studies were carried out on a total of 234 patients with OTCS, all of whom had undergone SFT. Evaluation of urologic symptoms revealed that 40-100% of patients with OTCS suffered from urinary instability. Moreover, its improvement rate after SFT was estimated at 59-100%. Evaluation of neurological symptoms indicated that 25-69% of patients with OTCS suffered from back/leg pain, And its improvement rate, the symptoms of back/leg pain of all patients were resolved or improved after SFT. Lower extremity weakness was found in 9-40% of patients with OTCS which was resolved or improved after SFT in about 25-100% of patients. Nevertheless, surgical indications for occult tight filum terminale syndrome remain controversial. CONCLUSION Although it seems that the SFT in OTCS patients is promising in treating neurologic, orthopedic and urological symptoms, usage of surgical untethering for patients with OTCS is a controversial issue. Clinical evaluation and urodynamic testing can be used to identify patients with OTCS. However, a multidisciplinary diagnostic work-up is strongly recommended for every child with OTCS.

To analyze the impact of the initial vision and surgical time for endoscopic transnasal/transethmosphenoid optic canal decompression (ETOCD) in the treatment of indirect traumatic optic neuropathy (TON). This retrospective case series analysis included 72 patients with indirect TON who underwent ETOCD from August 2017 to May 2019. Visual acuity (VA) was compared before and after surgery to estimate the improvement rate. The overall VA improvement rate of ETOCD was 54.2%. There were 83.3% and 33.3% improvement rate of patients with residual vision and blindness, respectively. VA was improved in 60.9% of patients treated within 3 days, 61.5% treated within 7 days, and 35.0% treated later than 7 days. Of the blindness patients, 50.0%, 37.5%, and 0.0% were treated within 3 days, 3–7 days, and later than 7 days, respectively. Of patients with residual vision, 85.7%, 92.3%, and 70.0% were treated within 3 days, 3–7 days, and later than 7 days, respectively. A statistically significant difference was found between patients with residual vision and those with blindness (P

To investigate the changes of spinal cord angle between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy in treating severe ossification of the posterior longitudinal ligament (OPLL). Seventy-one patients with cervical OPLL were enrolled. Patients in this study were divided into group A and group P. Japanese Orthopaedic Association (JOA) score was utilized to evaluate the neurological function. Radiological assessments included the spinal cord angle, Cobb angle, and area of the spinal cord. Surgery-related complications were also recorded. At the final follow-up, patients in group A had better recovery of local and whole cord angle, and the area of the cord than those in group P (all p

Introduction Anterior cervical decompression and fusion surgery using traditional methods to remove the posterior longitudinal ligament often causes massive bleeding, increasing the risk of surgery. However, the use of a high-frequency electrotome under the microscope can significantly reduce bleeding and reduce the risk of surgery. Aim To explore the clinical significance of electrosurgical excision of the posterior longitudinal ligament in the cervical anterior approach under the microscope. Material and methods From December 2015 to December 2017, patients who underwent anterior cervical discectomy and fusion at our hospital were followed up. We enrolled 73 men and 50 women who were 30 to 74 years old (mean, 49.96 years). Among 67 patients in group A treated with a high-frequency electrosurgical knife under the microscope, 58 were followed up; among 73 patients in group B treated with a traditional cervical hook knife under the microscope, 65 were followed up. Clinical data, operative time, intraoperative bleeding volume, VAS score, and Japanese Orthopaedic Association (JOA) improvement rate were retrospectively analyzed. Results There were significant differences in the mean operative time and intraoperative bleeding volume between the two groups (p < 0.05); however, no significant differences were found in the incidence of cerebrospinal fluid leakage, JOA improvement rate at 3 months postoperatively, and VAS score at 3 months postoperatively between the two groups (p > 0.05). Conclusions Electrosurgical resection of the posterior longitudinal ligament of the cervical vertebrae under the microscope can significantly reduce intraoperative bleeding and shorten the operative time and has obvious advantages compared with traditional methods.

Objectives This study aimed to investigate the effect factors associated with the postoperative dissatisfaction of patients undergoing open-door laminoplasty for cervical OPLL. Methods In this study, 194 patients, who underwent open-door laminoplasty for cervical OPLL from January 2009 to January 2016, were retrospectively reviewed. The Patient Satisfaction Index (PSI) was collected at discharge, 6 months, 1 year, and the last follow-up. According to the PSI, patients were divided into satisfied group and dissatisfied group. The possible effect factors included demographic variables and surgery-related variables. Results At discharge, 42 (21.6%) patients were in the dissatisfied group, as compared to the satisfied group, the hospitalization cost, hospital stay, postoperative depression, the axial neck pain, delayed wound healing, and VAS-neck had significant statistical differences. At 6-month follow-up, 25 (12.9%) patients were in the dissatisfied group. The axial neck pain and JOA score had significant statistical differences between the two groups, and no significant differences were found between the two groups in other items. At 1 year with 18 (9.3%) dissatisfied patients and last follow-up with 14 (7.2%) dissatisfied patients, the JOA score and symptom recurrence had significant statistical differences. For further analysis, the dissatisfied patients with axial neck pain at 6 months were significantly higher than that at other terms and the JOA score of the two groups increased gradually with prolonging of restoration years but compared with the dissatisfied group, the JOA scores were obviously better in the satisfied group at the last follow-up. Conclusions Overall, to patients undergoing open-door laminoplasty for cervical OPLL, hospitalization cost and neck pain might be mainly associated with patient dissatisfaction at the early and middle recovery. Patient dissatisfaction at the long-term treatment outcome might be mainly associated with the low improvement rate of JOA score and symptom recurrence.

Introduction Spinal cord herniation (SCH) is a rare cause of progressive myelopathy and Brown-Sequard-Syndrome. Research question Evaluation of functional outcome after SCH treatment compared to conservatively treated patients. Material and methods We retrospectively analysed functional outcome in SCH patients treated between 2009 and 2020. We conducted a systematic search using PubMed, MEDLINE and EMBASE to perform a pooled analysis in SCH patients. Results Our hospital cohort included 17 patients of which 9 were treated surgically. Mean age was 51.9 years, 58.8% of the patients were female. In 4/9 patients (44.4%) the neurological state remained stable after surgery. Four patients improved (44.4%) and one deteriorated after surgery (11.1%). Conservatively treated patients had a higher deterioration rate on follow-up with 3/8 patients deteriorating (37.5%). In our pooled analysis, 109/145 (75.2%) of patients improved, 32/145 (22.1%) remained stable and 4/145 patients deteriorated (2.8%). Among the available data of nine cohorts, mean recovery rate measured by the JOA score was 36.6% (SD 14.4). In our pooled multivariable model lower preoperative JOA score was associated with worse functional outcome (OR 0.86, 95%CI 0.74–0.99, p ​= ​.04). Discussion and conclusion Our data shows that patients who are treated surgically have a higher improvement rate and acceptable perioperative morbidity compared to conservatively treated patients. Lower preoperative JOA score decreases chances of improved functional outcome on follow-up. We therefore advocate early surgery for symptomatic patients. Wait and see appears outdated due to progressive impairment and decreased chances of recovery. However, it is still an option in asymptomatic incidental SCH patients.

Objective: To analyze the functional outcomes after arthroscopic treatment of femoroacetabular impingement (FAI). Methods: 194 patients (131 males and 63 females), with a mean age of 39 (15-68) years old for men and 43 (16-58) years old for women. The average follow-up was 17 months (2 to 71). 103 patients presented Cam-type FAI, 102 mixed and 25 Pincer. “Unilateral” arthroscopy was performed in 161 cases, “Bilateral” (only once each side) in 46 cases and, “Multiple” (more than one procedure on the same hip) in 23. The female sex was prevalent in the Pincer type FAI (76%), while males were prevalent in Mixed and Cam type, 74.5% and 72.8%, respectively. Results: The mean HHSpre score was 63.7 and 87.1 for HHSpost, i.e. 73.11%. Differences appeared between “mixed” and “unilateral” groups. The complications percentage in this series was 18.7% and 7% progressed to total hip arthroplasty. Conclusion: The arthroscopic FAI treatment improved the postoperative clinical scores of these patients, especially in cases of mixed-type FAI, which presented a higher improvement rate. Insufficient femoral osteoplasty was the main cause for surgical re-intervention, particularly in the initial cases of this series. Level of Evidence II, Retrospective study. RESUMO Objetivo: Avaliar os resultados funcionais após tratamento artroscópico do impacto femoroacetabular (IFA). Métodos: Foram selecionados 194 pacientes (131 do sexo masculino e 63 do sexo feminino), com idade média de 39 (15-68) anos no caso dos homens e 43 (16-58) anos para as mulheres. O seguimento médio foi de 17 meses (2 a 71). 103 pacientes apresentaram IFA tipo Came, 102 Misto e 25 tipo Pincer. A artroscopia única foi realizada em 161 casos; a bilateral (somente uma vez cada lado) em 46 casos e a múltipla (mais de um procedimento no mesmo quadril) em 23. O sexo feminino foi prevalente no IFA do tipo Pincer (76%) e o masculino nos tipos Misto e Came, 74,5% e 72,8%, respectivamente. Resultados: A média do escore HHSpré foi de 63,7 para HHSpós de 87,1, ou seja 73,11% Ficaram evidenciadas diferenças nos grupos “misto” e “único”. O percentual de complicações desta série foi de 18,7% e 7% evoluíram para artroplastia total do quadril. Conclusão: O tratamento artroscópico IFA melhorou os escores clínicos, principalmente nos casos de IFA do tipo misto, que apresentou maior taxa de melhora, A osteoplastia femoral insuficiente foi a principal causa para reintervenção cirúrgica, particularmente nos casos iniciais desta série. Nível de Evidência II, Estudo retrospectivo.

To evaluate the efficacy of chemoembolization for inoperable metastatic epidural spinal cord compression (MESCC) refractory to re-radiotherapy. Nineteen consecutive patients with recurrent MESCC after re-radiotherapy who had undergone chemoembolization were retrospectively analyzed. Outcome measures were pain relief rate, neurological improvement rate, objective response rate, and adverse events. MESCC degree classification was assessed using Bilsky grades. Pain assessment was performed using Numerical Rating Scale, and neurological function was evaluated using the Frankel classification. The median follow-up period was 7 (range 2–44) months. All participants had MESCC grade 2 or higher and had severe pain. Fifteen patients (79%) had neurological deficits, and ten had Frankel classification C and five had D. Symptoms were relieved in almost all patients the day following chemoembolization. Pain relief was achieved in 18 of 19 (95%) patients; the median decrease in Numerical Rating Scale score was 8 (range 0–10; p

Erbium: Yttrium-aluminum-garnet laser (Er: YAG) treatment has been used in resurfacing the acne scars for a long time; however, we could not find any study reporting the recovery rates after each session of the treatment. In this study, we aimed to report the improvement rates after each session. We retrospectively analyzed the data of 35 patients with acne scars treated with fractional ablative Er: YAG laser. The patients received one to four sessions of treatment with 4-week intervals and improvement rates were recorded after each session. Data are available on request from the authors. The improvement rate of the lesions varied between 1% and 25% in 34 patients at the end of the first session, while in one patient, the improvement rate was detected as 26% to 50%. At the end of the fourth session, the rate of improvement was 26% to 50% in 14 out of 24 patients and 51% to 75% in 10 patients. None of the patients showed a 76% to 100% improvement at the end of the fourth session, whereas 48.6% of the patients were satisfied with the treatment. In patients with a high expectation of an excellent improvement, a higher number of sessions of the laser treatment and/or combination treatments with different treatment methods should be planned. © 2020 Wiley Periodicals LLC.

Introduction Although the sphenopalatine ganglion (SPG) has been considered a site of therapeutic potential for cluster headache (CH), the optimal technique of SPG is still to be determined. Low-temperature plasma radiofrequency ablation (LTPRA) has been proposed as an alternative treatment for several neuropathic pain diseases. Aim To evaluate the effect of LTPRA of SPG in treating chronic and episodic CH. Material and methods The patients with CH, who achieved temporary pain relief following SPG block, treated using LTPRA between January 2015 and October 2017 were reviewed. Seventy-six patients were included: 50 patients suffered from episodic CH and the remaining 26 patients from chronic CH. The primary outcomes were clinical improvement rate, defined as the percentage of partial and complete pain relief results at 1 day, 12 months, and 24 months of follow-up after the operation. Results Clinical improvement rates were 92.3%, 92.3% and 73.1% in chronic CH and 73.1%, 84% and 68% in episodic CH at each follow-up time point, respectively. 3 chronic CH patients and 7 episodic CH patients showed no pain relief after the operation. Drooping eyelids were found in 2 cases, one recovered at the 3-month follow-up but another one did not in the 24-month follow-up. No serious complications occurred intraoperatively or postoperatively. Conclusions LTPRA can be considered an effective and alternative surgical modality in treating patients with chronic and episodic CH, based on SPG block.

Lymphaticovenous anastomosis (LVA) is now a common treatment for lymphedema. It is important to create as many bypasses as possible to maximize the efficacy of LVA. We have developed a method whereby nylon monofilaments are placed inside the vessel lumen to act as dilators. We refer to this technique as mechanical dilation (MD) to distinguish it from intravascular stenting. In this study, we investigated the efficacy of the conventional supermicrosurgery technique performed with and without MD as a treatment for lower limb lymphedema. The LVA was performed using conventional supermicrosurgery alone in 10 patients (group without MD) and in combination with MD in another 10 patients (group with MD). The mean number of successful LVAs performed per hour was significantly higher in the group with MD than in the group without MD (1.42 ± 0.16 vs 1.14 ± 0.15; P < 0.05). The mean amount of improvement in the lower extremity lymphedema index was significantly greater in the group with MD than in the group without MD (7.34 ± 1.57 vs 4.41 ± 1.53; P = 0.003 < 0.05). A statistically significant correlation was found between the number of successful LVAs and amount of improvement in lymphedema (r = 0.449, P = 0.047 < 0.05). Our findings suggest that use of MD does not shorten the operating time or increase the number of LVAs that can be performed but may make it possible to increase the number of successful LVAs that can be performed between vessels with a diameter of less than 0.3 mm. Use of MD could increase the improvement rate of lymphedema to a greater extent than that achieved by conventional microsurgery alone.

Supplemental Digital Content is available in the text., Background: Although patients with obesity-induced lymphedema can be treated by weight loss therapy, they find it difficult to lose the required amount of weight. The aims of this study were to clarify the characteristics of the lymphatic vessels in patients with obesity-induced lymphedema and to determine the feasibility and efficacy of lymphovenous anastomosis (LVA) in these patients. Methods: Twenty-two patients (44 edematous lower limbs) with a body mass index (BMI) >35 kg/m2 (obese group) and 91 patients with lymphedema (141 edematous lower limbs) and BMI

Background To evaluate the safety and outcomes of endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) for children with indirect traumatic optic neuropathy (ITON). Methods From July 1st, 2008 to July 1st, 2015, 62 children diagnosed with ITON who underwent ETOCD were reviewed. Main outcome measure was improvement in visual acuity after treatment. Results Altogether 62 children (62 eyes) with a mean age of 11.26 ± 4.14 years were included. Thirty-three (53.2%) of them had residual vision before surgery while 29 (46.8%) had no light perception (NLP). The overall visual acuity improvement rate after surgery was 54.84%. The improvement rate of patients with residual vision (69.70%) was significant higher than that of patients with no light perception (NLP) (37.9%) (P = 0.012). However, no significant difference was shown among patients with different residual vision (P = 0.630). Presence of orbital and/ or optic canal fracture and hemorrhage within the post-ethmoid and/or sphenoid sinus resulted in poor postoperative visual acuity, duration of presenting complaints did not affect final visual acuity or did not effect outcomes. Intervention performed in children presenting even after 7 days from the injury did not influence the final visual outcome. Three patients developed cerebrospinal fluid rhinorrhea and one encountered cavernous sinus hemorrhage during surgery. No other severe complications were observed. Conclusion Children with residual vision had better postoperative visual prognosis and benefited more from ETOCD than children with NLP. Intervention performed in children presenting even after 7 days from the injury did not influence the final visual outcome, however, this needs to be reassessed in children presenting long after the injury.Treatment should still be recommended even for cases of delayed presentation to hospital.

The criteria for surgical cure of acromegaly have become more stringent during the past decades and a change from Cortina to new consensus criteria has recently been proposed. However, the superiority of the new consensus over Cortina criteria with respect to postoperative metabolic parameters remains to be ascertained. We retrospectively assessed metabolic parameters, the body habitus, and other health-related parameters of 48 patients with surgically controlled acromegaly who met the Cortina criteria [normalized insulin-like growth factor-1 (IGF-1) level and nadir growth hormone (GH) level

Background Lumbar puncture (LP) is an essential part of adult neurology residency training. Technologic as well as nontechnologic training is needed. However, current assessment tools mostly focus on the technologic aspects of LP. We propose a training method—problem- and simulator-based learning (PSBL)—in LP residency training to develop overall skills of neurology residents. Methods We enrolled 60 neurology postgraduate-year-1 residents from our standardized residents training center and randomly divided them into 2 groups: traditional teaching group and PSBL group. After training, we assessed the extent that the residents were ready to perform LP and tracked successful LPs performed by the residents. We then asked residents to complete questionnaires about the training models. Performance scores and the results of questionnaires were compared between the 2 groups. Results Students and faculty concluded that PSBL provided a more effective learning experience than the traditional teaching model. Although no statistical difference was found in the pretest, posttest, and improvement rate scores between the 2 groups, based on questionnaire scores and number of successful LPs after training, the PSBL group showed a statistically significant improvement compared with the traditional group. Findings indicated that nontechnical elements, such as planning before the procedure and controlling uncertainties during the procedure, are more crucial than technical elements. Conclusions Compared with traditional teaching model, PSBL for LP training can develop overall surgical skills, including technical and nontechnical elements, improving performance. Residents in the PSBL group were more confident and effective in performing LP.

SummaryObjective To investigate the clinical application and efficacy of intradermal injection of low molecular weight hyaluronic acid (LMW-HA) for treating enlarged facial pores. Methods From January 2015 to May 2016, 42 subjects who sought aesthetic treatment underwent intradermal injection of LMW-HA to improve enlarged facial pores. For each treatment, 2.5 mL (25 mg) of LMW-HA was injected into the skin of the full face. The treatment was repeated 2-5 times with an interval of 1 to 1.5 months between consecutive treatments. The postoperative follow-up period was 1 to 6 months. Statistical analysis was used to compare the degree of enlargement of facial pores before and after injection. The clinical efficacy and adverse effects were recorded. Results The enlarged facial pores before and after treatment were categorized and subjected to the Wilcoxon matched-pairs signed-rank test. The difference was statistically significant (P

The aim was to explore the factors contributing to a high degree of satisfaction following total hip arthroplasty in patients with ankylosing spondylitis and hip joint fusion. From January 2001 to June 2015, 43 patients with ankylosing spondylitis were treated with total hip arthroplasty. The patients were divided into two groups, including 20 patients in non-fusion groups, with 25 cases of hip non-fusion, and 23 patients in fusion groups, with 40 cases of hip fusion. Patients were followed for an average of 27 months. Harris hip scores (HHSs) and Barthel scores were recorded pre-operatively and post-operatively. The improvement rates of both groups were calculated, and the data were compared and analyzed. The Self-Administered Patient Satisfaction Scale (SAPS) was used to assess the degree of satisfaction in each group. The post-operative HHS and Barthel scores of two groups both significantly improved. In non-fusion groups compared with fusion groups, there were significant differences in the pre-operative HHSs, the improvement of the HHSs, the pre-operative Barthel score, the improvement of the Barthel score, and the satisfaction score. However, there were no significant differences in the post-operative HHSs and Barthel scores. Patients in the hip fusion group had higher satisfaction scores. The improvements in joint function and self-care ability after total hip arthroplasty are the decisive factors in determining patient satisfaction for patients with ankylosing spondylitis combined with hip fusion.

BACKGROUND We aimed to compare microscope-assisted anterior cervical surgery with traditional open-base surgery for treating cervical ossification of the posterior longitudinal ligament (OPLL). MATERIAL AND METHODS Patients were grouped into microscope-assisted anterior cervical surgery group (case group, n=30) and conventional anterior cervical surgery group (control group, n=30). Baseline characteristics, intraoperative and post-operative indexes including operation time, blood loss amount, duration of hospitalization, visual analogue scale (VAS), and complication rate were recorded. The neurological functions of patients were assessed using the Japanese Orthopaedic Association (JOA) score. Furthermore, the corresponding rate of improved JOA score (RIS) in each group was also calculated to evaluate surgery outcomes. RESULTS The average blood loss amount and hospital stay duration in the case group were lower than in the control group (p

Katar, Salim (Balikesir Author), Introduction and Aim: Chiari malformation is a congenital anomaly formed as the result of the herniation of posterior fossa structures through the foramen magnum toward the spinal canal. In this study, we aimed to present the improvement rate regarding the herniation in cerebellar tonsils following shunting procedures in patients with Chiari malformation and associated hydrocephalus. Method: We measured in mm the improvement rate regarding the herniation in cerebellar tonsils in postoperative cervical MRI images obtained following ventriculoperitoneal shunting procedures for hydrocephalus in adult patients with symptoms of Chiari malformation such as balance disorder, dizziness, numbness and loss of muscular strength at the hands who were diagnosed with Chiari malformation and hydrocephalus following cranial and cervical magnetic resonance imaging (MRI). Results: A total of fifteen adult patients in whom the cerebellar tonsillar herniation was over 5 mm and accompanied by hydrocephalus were included in our study. The measure of herniation in the patients involved in the study was between 1.11 cm and 8 mm. The amount of improvement in herniation following the shunting procedure was between 7.76 mm and 2.2 mm. Conclusion: In patients with Chiari malformation associated with hydrocephalus, cerebellar tonsillar herniation can regress to 5 mm, which is considered as physiological, and the symptoms related to Chiari malformation can disappear. When Chiari malformation is associated with hydrocephalus, the tonsillar herniation may improve, and symptoms may disappear following the ventriculoperitoneal shunting procedure for hydrocephalus without necessitating posterior decompression for Chiari-related herniation.

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents, and it is also a potentially painful and debilitating condition. To date, no specific studies have prospectively evaluated the efficacy of its treatment and no robust standard of care has been established. Therefore, a systematic review (2007–2020) with a pooled analysis was performed in order to compare MRONJ surgical techniques (conservative or aggressive) versus combined surgical procedures (surgery plus a non-invasive procedure), where 1137 patients were included in the pooled analysis. A statistically significant difference in the 6-month improvement rate, comparing combined conservative surgery versus only aggressive (91% versus 72%, p = 0.05), was observed. No significant difference regarding any group with respect to the 6-month total resolution rate (82% versus 72%) was demonstrated. Of note, conservative surgery combined with various, adjuvant, non-invasive procedures (ozone, LLLT or blood component + Nd:YAG) was found to achieve partial or full healing in all stages, with improved results and the amelioration of many variables. In conclusion, specific adjuvant treatments associated with minimally conservative surgery can be considered effective and safe in the treatment of MRONJ, although well-controlled studies are a requisite in arriving at definitive statements

Objective Recovery of hand motor function after surgical treatment in myelopathy patients is commonly observed. Accurate evaluation of postoperative hand function contributes to assessing the efficacy of surgical treatment. However, no objective and effective evaluation method has been widely accepted in clinical practice. Therefore, the study aimed to explore the value of Myelopathy-hand Functional Evaluation System (MFES) in assessing the postoperative hand function for myelopathy patients. Material and method MFES mainly consist of a pair of wise-gloves and a computer with software. One hundred and thirty myelopathy patients were included and all of them received optimal surgery treatment. The Japanese Orthopaedic Association (JOA) scores were marked at preoperative and at 6 months after surgery. All patients were asked to perform the 10-s grip and release test, and the hand movements were simulated and converted into waveforms by MFES. The waveform parameters were measured and analyzed. Results The JOA scores and the number of grip-and-release (G–R) cycles significantly increased after surgery. Correspondingly, the waveforms of ulnar three fingers were significantly higher and narrower, along with the significantly declined average time per cycle in postoperative. The a/b ratio (Wave height/wave width) of five fingers were significantly higher in postoperative than that in preoperative. Based on the improvement rate of a/b, the excellent and good rate of surgical outcomes was 62.30 %, which was significantly higher than that (47.69 %) based on the improvement rate of JOA scores (P = 0.019). Conclusion MFES is an effective assessment tool in evaluating the postoperative hand function for myelopathy patients.

STUDY DESIGN Retrospective review. OBJECTIVE To describe a safe surgical procedure, en bloc resection of the posterior wall of the thoracic canal, for the decompression of severe thoracic myelopathy caused by tuberous ossification of the ligamentum flavum (OLF). SUMMARY OF BACKGROUND DATA OLF has been widely recognized as a cause of thoracic myelopathy in East Asia. Surgical decompression of thoracic myelopathy caused by OLF is technically demanding. Although several surgical decompression procedures have been described, acute neurological deterioration is common. MATERIALS AND METHODS Eighteen patients with severe thoracic myelopathy caused by tuberous OLF underwent posterior decompression via segmental en bloc resection of the posterior wall of the thoracic canal. The ossified ligamentum flavum, laminae, and partial facet joints of each segment were resected en bloc. Ossified dura mater was removed if present. Posterior fixation with pedicle screws was followed by lateral bone graft fusion. RESULTS The mean preoperative modified Japanese Orthopaedic Association score (total score, 11) was 4.1 (range, 2-5). Postoperatively, no neurological deterioration occurred, and all patients improved clinically. With an average follow-up of 31.2 months (range, 24-42 mo), the average modified Japanese Orthopaedic Association score was 7.8 (range, 6-10), representing a 2- to 5-point improvement. The average improvement rate was 55.2% (range, 33.3%-83.3%). Most patients were functionally independent at the last follow-up. Forty ossified segments were resected. The average time required for the resection of 1 segment was 77 minutes. Intraoperatively, dural ossification was noted in 11 patients. Complete resection was performed in all patients. Cerebrospinal fluid leakage occurred in 5 patients. CONCLUSION Segmental en bloc resection of the posterior wall of the thoracic canal is a safe and effective alternative for OLF-related severe thoracic myelopathy.

Objective: To retrospectively evaluate appropriate treatment for patients with symptomatic caliceal diverticular calculi, by comparing the therapeutic outcomes for those undergoing minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureterorenoscopy (F-URS). Methods: From March 2009 to May 2014, 36 consecutive patients with caliceal diverticular calculi were divided into 2 groups: 21 patients underwent MPCNL, and 15 were treated by F-URS. All procedures were performed by one surgical group, which ensured relatively constant parameters. Patient characteristics, operative time, hospital stay after surgery, stone-free rate, symptomatic improvement rate, complications, diverticular obliteration, and stone composition were analyzed retrospectively in the 2 groups. Results: Patient preoperative variables were comparable between the two groups, with no significant difference (P > 0.05). Mean operative time was 136.9 ± 22.8 min in the MPCNL group and 117.3 ± 24.3 min in the F-URS group (P = 0.019). Hospital stay was significantly longer in the MPCNL group than in the F-URS group (9.4 ± 3.1 vs. 6.9 ± 2.1 days, P = 0.010). The stone-free rates after MPCNL and F-URS were 90.5% (19/21) and 60.0% (9/15), respectively (P = 0.046). Additionally, 71.4% (15/21) of patients in the MPCNL group and 46.7% (7/15) of patients in the F-URS group had symptomatic improvement at the 6-month follow-up (P = 0.175); the rates of complications in the 2 groups were 19.0% (4/21) and 13.3% (2/15), respectively (P = 0.650). Complete diverticular obliteration was achieved in 16 (76.2%) cases in the MPCNL group and 5 (33.3%) cases in the F-URS group (P = 0.017). The distributions of calcium oxalate and hydroxyapatite in the stones were 66.7% (14/21) and 33.3% (7/21), respectively, in the MPCNL group; however, the distributions in the F-URS group were 46.7% (7/15) and 53.3% (8/15), respectively (P = 0.310). Conclusion: MPCNL is an effective method for the treatment of caliceal diverticular calculi. However, F-URS is an alternative technique in selected patients with a patent infundibulum, despite lower stone-free rates than with MPCNL. Fulguration of the diverticular lining with a high-power holmium laser and permitting the cavity to collapse are useful to increase the chance of diverticular obliteration. Keywords: Caliceal diverticular calculi, Minimally invasive percutaneous nephrolithotomy, Flexible ureterorenoscopy

The use of a transoral atlantoaxial reduction plate (TARP) system is an effective surgical approach for the treatment of basilar invagination. With the aim of improving the therapeutic efficacy of the TARP operation, we conducted a voxel-based morphometric study to quantitatively investigate the descent of the odontoid process and craniocervical volume changes.We enrolled 20 patients with basilar invagination who underwent a TARP procedure. Craniocervical computed tomography (CT) scanning and a 3-dimensional (3-D) reconstruction of the craniocervical junction were performed. Craniocervical volumes and odontoid process descent distances were measured preoperatively and postoperatively. Individual neurological function was evaluated according to the Japanese Orthopaedic Association (JOA) scoring system for cervical disorders. Pearson correlation analysis was applied for statistical testing.Surgical efficacy (the JOA-score improvement rate) was significantly associated with the craniocervical volume improvement rate, the odontoid descent distance, and the absolute craniocervical volume changes (p0.01 for all), with correlation coefficients (r) of 0.83, 0.80, and 0.61, respectively. No significant correlation was noted between surgical efficacy and age, symptom duration, preoperative neurological function, odontoid process displacement, or change in clivus-odontoid angle (p0.05). The craniocervical volume improvement rate was significantly associated with the odontoid descent distance (r = 0.8; p0.01), but it was not associated with the odontoid displacement or the change in the clivus-odontoid angle (p0.05).We found that the odontoid descent distance predicted the craniocervical volume improvement rate following TARP procedures in patients with basilar invagination, and we believe that both can serve as predictors of surgical efficacy. We believe that planning the odontoid descent distance preoperatively may help to improve the efficacy of TARP operations.Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objective To observe the hemostatic effect of the Spleen-invigorating, Qi-replenishing and Blood-arresting Formula on simvastatin-induced zebrafish hemorrhage model compared with that of the Heat-clearing and Blood-cooling Formula. Methods AB strain wild type zebrafish were treated with 0.5 μM simvastatin for 24 hours to establish the zebrafish hemorrhage model. Under strictly blind experimental conditions, the zebrafish were then treated with experimental agents in different concentration within the maximum non-lethal dose. The intervention effect of the Spleen-invigorating, Qi-replenishing and Blood-arresting Formula was comprehensively assessed by examining the main observational parameters such as the bleeding reduction rate and hemostatic rate while referring to the additional parameters such as blood flow, improvement rate of blood flow, velocity of movement, improvement rate of motion under spleen-qi deficiency. Results Hemostatic effect: The bleeding rate and hemostatic rate in the zebrafish were respectively, 30%, 15%, 45%, 40% and 60%, 80%, 40%, 47% when equal concentration of 500 μg/mL, 1000 μg/mL were used. This showed that the experimental herbs B1 was superior to B2 in decreasing the bleeding rate and improving hemostatic effect in the zebrafish. Improvement of blood flow: With equal concentration, the experimental herb B1 was superior to B2 in increasing the blood flow and improvement rate of blood flow in hemorrhagic zebrafish. Promotion of the improvement of motion: With equal concentration of 500 μg/mL and 1000 μg/mL, the experimental herb B1 was superior to B2 in promoting the velocity of motion in the zebrafish and promoting the improvement rate of motion. Conclusion The manifestations of simvastatin-induced zebrafish hemorrhage are basically similar to that of failure of the spleen to control blood in human beings. The Spleen-invigorating, Qi-replenishing and Blood-arresting Formula has good hemostatic effect on simvastatin-induced hemorrhage in the zebrafish. It also boasts the functions of improving blood flow and velocity of motion in the hemorrhagic zebrafish. Such a conclusion provides the experimental basis for the treatment of the syndrome of failure of the spleen to control blood by this formula.

Background In many countries, gastric cancer is not diagnosed until an advanced stage. An Internet-based e-learning system to improve the ability of endoscopists to diagnose gastric cancer at an early stage was developed and was evaluated for its effectiveness. Methods The study was designed as a randomized controlled trial. After receiving a pre-test, participants were randomly allocated to either an e-learning or non-e-learning group. Only those in the e-learning group gained access to the e-learning system. Two months after the pre-test, both groups received a post-test. The primary endpoint was the difference between the two groups regarding the rate of improvement of their test results. Findings 515 endoscopists from 35 countries were assessed for eligibility, and 332 were enrolled in the study, with 166 allocated to each group. Of these, 151 participants in the e-learning group and 144 in the non-e-learning group were included in the analysis. The mean improvement rate (standard deviation) in the e-learning and non-e-learning groups was 1·24 (0·26) and 1·00 (0·16), respectively (P, Highlights • This report establishes that an e-learning system on the Internet can improve the diagnostic ability of endoscopists. • Countless endoscopists worldwide can access the system to learn how to make an endoscopic diagnosis of early gastric cancer. • The e-learning system could be modified to provide education regarding endoscopic diagnosis in other organs. This is the first report to demonstrate how an e-learning system based on the Internet can improve the diagnostic ability of gastrointestinal endoscopists worldwide. There is no limit to the number of endoscopists who can access the system and benefit from this opportunity to learn how to make an endoscopic diagnosis of early gastric cancer. This e-learning system could be modified to provide education regarding endoscopic diagnosis in other organs such as the large intestine and the esophagus, as well as the stomach. It may contribute to human welfare and health by reducing the mortality from gastrointestinal cancer.

Freckles are melanocytic lesions frequently seen on the face with red or blond hair. We aim to determine the effectiveness of combined bipolar radiofrequency (RF) and optical energy.Thirty patients with facial freckles received four treatment at 3-week intervals with RF and optical energy, combination of broadband light (580-980 nm) + bipolar RF energy 100 J/cm(3). The improvement of the freckles was evaluated using the Freckles Area and Severity Index (FASI), and physician and patient assessment at the end of the sessions, at Months 3 and 12 after the treatment.By the end of the study, assessment of results by physician for 83% at Week 12 and by patients for 70% at Week 52 was excellent or good. On the other hand, 88% at Week 12 and 76% at Week 52 of the patients reported that they were extremely or very satisfied. FASI was noted to be 65.15 at pre-treatment, 25.60 at 12th week, and 27.40 at the end of the follow-up (one year). Mean improvement rate (n = 30), as determined from the difference in mean FASI score, was 70% at 3 months and 66% at 12 months.Bipolar radiofrequency and optical energy can be accepted as an alternative treatment modality for the therapy of freckles with few adverse effects and high satisfaction levels.

Cutaneous leishmaniasis is an endemic disease in Iran. Unfortunately, it can lead to unsightly atrophic scars with limited treatment options. Fractional CO2 laser is accepted for treatment of atrophic acne scars and recently has been used to treat cutaneous leishmaniasis, so we planned to use fractional CO2 laser on leishmaniasis scar. We conducted this study on 60 leishmaniasis scars on the face of 40 patients. The lesions were treated by a fractional CO2 laser with beam size of 120 μm, with energy of 50-90 mJ, and 50-100 spots/cm(2) density with two passes in three monthly sessions. Evaluation was done in the first and second months after the first treatment and 3 and 6 months after the last treatment. Digital photography was performed at each visit. Assessment of improvement rate by patient and physician was rated separately as follows: no improvement (0%), mild (

The purpose of the current study was to evaluate the prognostic value of intraoperative improved transcranial motor evoked potential (MEP) after cervical cord decompressive surgery for cervical compressive myelopathy (CCM). A consecutive series of 59 CCM patients who underwent cervical cord decompressive surgery were studied between December 2013 and April 2015 in this study. And all patients were divided into three subgroups: the patients with intraoperative improved MEP, without obvious MEP change and MEP degeneration. MEP and modified Japanese Orthopedic Association (mJOA) score were mainly utilized to assess intra-, pre- and post-operative neurologic function; all patients had reliable and stable MEP baseline. The early neurologic outcomes and the long-term mJOA improvement rate were evaluated after surgery. There were 21 patients with intraoperative monitoring improvement (MEP improved rate, 140 ± 76 %), 32 patients without obvious MEP change and six patients with MEP degeneration. The early motor or sensory outcome showed varying degrees of recovery in the MEP improvement group. The long-term mJOA improvement rate among the three groups was 59.5 ± 4.2, 48.9 ± 3.9 and 40.6 ± 7.4 %, respectively, after 6-month follow-up, and the improvement group was better than the other two groups with statistical significance (59.5 ± 4.2 vs. 48.9 ± 3.9 %, p

BACKGROUND: The aim of the present study was to discuss the efficacy of delayed wider endoscopic optic decompression in traumatic optic neuropathy (TON). METHODS: A total of 479 patients were treated with corticosteroids and delayed wider endoscopic optic decompression, including the injury-to-surgery interval, within 2 weeks in patients with no light perception (NLP), and within 1 month in patients with residual eyesight. Based on the traditional decompression range, the superior wall of the optic canal was further decompressed. The preoperative and postoperative visual acuities (VAs) were reviewed, and the therapeutic efficacy was analyzed. RESULTS: The final VA was 0.1 or better in 29 cases, finger count in 79 cases, hand motion in 99 cases, light perception (LP) in 25 cases, and NLP in 247 cases. A total of 136 patients (136/383, 35.5%) recovered after NLP treatment, and 78 patients (69/96, 71.9%) had improved residual eyesight. The improvement rate in patients with residual eyesight was significantly higher than that of patients with NLP (P

Objective Flow diversion is a popular technique used to treat ordinary small, as well as complex internal carotid artery (ICA) aneurysms. We describe aneurysm occlusion rates, complications and patient outcomes in patients with ICA aneurysms treated with flow diverter stents. Patients and methods We identified all consecutive patients with ICA aneurysms that were treated with flow diverter stents between 2014 and 2019 at our institution. We divided the aneurysms into two anatomic subgroups (cavernous and supraclinoid segments). All the imaging studies and medical records were reviewed for relevant features in relation to aneurysms, complications and patient outcomes. Results A total of 62 patients with 76 ICA aneurysms (72 unruptured; 4 ruptured) were treated with 70 flow diversion procedures, including six re-treatments. Complete aneurysm occlusion was achieved in 61 % of patients at 6-month follow-up (cavernous 69 %, supraclinoid 58 %), and in 69 % at the latest follow-up (mean of 18 months). Postprocedural intracranial ischemia or hemorrhage was seen in 24 % of patients, including two aneurysm ruptures after flow diversion, and related major long-term functional decline or mortality was seen in 6% of patients. Preprocedural dysfunction of extraocular muscles or vision disturbance improved moderately at best (40–60 %). At the latest follow-up, 54 patients (87 %) were functionally independent (mRS ≤2). Conclusion Flow diversion for cavernous and supraclinoid ICA aneurysms demonstrated acceptable results, but complex aneurysm features cause uncertainty in predicting aneurysm occlusion probability. Patients should be informed of the non-negligible rate of complications, and of only moderate improvement rate of cranial nerve dysfunctions.

To evaluate the surgical outcome of using a trepan to treat single-segment ossification of ligamentum flavum under endoscopy and the clinical value of the new surgical treatment.Patients who underwent surgery for single-segment ossification of ligamentum flavum from January 2015 to June 2018 were included in a retrospective analysis. Endoscopic visual trepan decompression was performed in 26 patients and posterior spinal canal resection and decompression was performed in 11 patients. Japanese Orthopaedic Association scores, Japanese Orthopaedic Association improvement rate, and visual analog scale scores of both groups were recorded during follow-up. Computed tomography was used to evaluate patients' residual area ratio of the vertebral canal. Operative time, length of stay, amount of bleeding, and hospital cost in both groups were recorded.Average follow-up time was 8.9 ± 2.7 months. Average operative time was 100.6 ± 35.0 minutes in the experimental group and 140.5 ± 28.3 minutes in the control group. At the final follow-up, the average improvement rate of Japanese Orthopaedic Association score was 78.3% in the experimental group and 84.2% in the control group. The average residual area ratio of the vertebral canal, which was50% before the operation in both groups, recovered to 100% in both groups after the operation. Visual analog scale score of all patients was significantly (P0.05) reduced at the final follow-up.The visual trepan technique using a spinal endoscope can be used to treat single-segment ossification of ligamentum flavum. Advantages include less trauma, faster recovery, and lower cost. However, more cases and long-term follow-up are required to further evaluate the clinical effectiveness and safety of this surgical method.

Objective Although microvascular decompression (MVD) is the primary treatment for hemifacial spasm (HFS), the postoperative course is variable. This study aimed to develop a prediction model of the outcome of MVD in patients with HFS by investigating influential factors. Methods Electronic medical records of 1624 patients with HFS who underwent MVD from July 2004 to January 2015 were reviewed. The relationships between patient-related, disease-related, and surgery-related factors and postoperative outcome were analyzed using multinomial logistic regression. A predictive model for MVD outcome was developed using decision tree analysis. Results The mean follow-up duration after surgery was 30.2 months (median, 23.5 months; range, 6.0–133.3 months). For the 1624 patients, the overall improvement rate was 90.5%. Overall, 984 patients (60.6%) showed improvement of spasm immediately after surgery, 486 (29.9%) experienced delayed improvement, and 154 (9.5%) showed persistence of spasm. Outcome of patients with HFS after MVD was predicted by 4 items: postoperative delayed facial palsy, degree of preoperative spasm, intraoperative indentation on the facial nerve, and sex. The patients were classified into 6 categories and improvement of spasm immediately after surgery showed 35%–91%, delayed improvement 6%–46%, and persistence of spasm 0%–59%. The accuracy of the developed prediction model was 0.608. Conclusions Male sex, mild degree of preoperative spasm, intraoperative indentation on the facial nerve, and postoperative delayed facial palsy were better favorable prognostic factors of MVD in patients with HFS. This novel algorithm may be useful to predict the outcome of MVD in these patients.

BACKGROUNDS Cross-face nerve grafting (CFNG) is an important treatment for patients with facial palsy. Currently, two-stage CFNG is frequently performed. CFNG is performed first, followed by coaptation when innervation reaches the grafted nerve ending. The present study compared single-stage CFNG with conventional two-stage CFNG. METHODS We retrospectively reviewed data of 17 patients who underwent CFNG with zygomatic and buccal branch with hypoglossal crossover. Patients with single-stage (group 1) and two-stage (group 2) CFNG were comparatively analyzed 2 years postoperatively. There were nine and eight patients in groups 1 and 2, respectively. The patient's perioperative status was measured with imaging and animation using the Yanagihara grade, altitude, and angle differences of the oral commissure and eye closure. RESULTS Patients in group 1 could recognize their first postoperative spontaneous movement earlier than those in group 2 (268.3 ± 25.1 days vs. 327.5 ± 51.3 days, respectively, p = 0.015). The Yanagihara grade significantly improved for patients in both groups postoperatively (group 1: 12.8 ± 5.5 to 25.3 ± 6.1, p

Objective The effects of dural release on extended laminoplasty for the treatment of multi-level cervical myelopathy were explored and discussed. Method Patients, who underwent extended laminoplasty combined with dural release for the treatment of multi-level cervical myelopathy (35 cases, group A), were compared with patients who underwent simple extended laminoplasty (38 cases, group B). The JOA score, improvement rate, VAS score, distance of retroposition of the spinal cord, cervical lordosis were compared between the two groups. Results Dural laceration occurred to five patients during surgery, three in group A and two in group B; cerebrospinal fluid leakage occurred to five patients, three in group A and two in group B. All patients were followed up for 10 to 48 months (mean 20.3 months). JOA scores and VAS scores in the last follow up period were significantly improved in the two groups than preoperative scores (p 0.05), and the distance of retroposition of the spinal cord in group A was higher than B (p