Experimental Study of Multi-slice Spiral CT Perfusion Imaging in VX_ 2 Soft-tissue Tumor of Rabbits

An experimental animal model of malignant soft-tissue tumor was established to investigate the applied value of multi-slice spiral CT perfusion imaging preliminarily. Ten New Zealand white rabbits which were implanted with VX2 tumor in either proximal thigh were subjected to CT plain scan and perfusion scan two weeks later respectively, then the original perfusion images were transmitted to AW4.0 Workstation. The functional maps and perfusion parameters including blood flow （BF）, blood volume （BV）, mean transit time （MTT） and permeability surface （PS） were computed and analyzed. All the values of BF, BV and PS in VX2 soft-tissue tumors were obviously higher while the MTT-values were lower than those in the normal muscular tissues significantly. It was suggested that multi-slice spiral CT perfusion imaging is an accurate, convenient and relatively safe functional imaging technique, and can give a quantitative assessment to angiogenesis and blood perfusion of soft-tissue tumors.

Magnetic resonance imaging of soft-tissue tumors of the extremities: A practical approach

Diagnosis of extremity soft-tissue tumors can be challenging.Characteristics of tumor margins can help precisely identify locally aggressive or non-aggressive behavior for surgical planning,but cannot differentiate benign from malignant lesions.Most malignant tumors can have inhomogeneous signals on T2-weighted images.Although a uniform signal on T2-weighted images can be a reliable indication of a benign lesion,a well-defined mass with homogeneous internal signal intensity does not definitively identify a benign lesion.Some common and distinctive soft-tissue lesions can have specific clinical and imaging features allowing a diagnosis without biopsy.These are known as determinate lesions.This illustrative report presents a diagnostic guide for extremity soft-tissue tumors based on tissue signal and morphological characteristics on magnetic resonance images.It is important for clinicians to be familiar with the imaging characteristics of common determinate lesions.

Anterior glenohumeral instability:Current review with technical pearls and pitfalls of arthroscopic soft-tissue stabilization

The glenohumeral joint(GHJ)allows for a wide range of motion,but is also particularly vulnerable to episodes of instability.Anterior GHJ instability is especially frequent among young,athletic populations during contact sporting events.Many first time dislocators can be managed non-operatively with a period of immobilization and rehabilitation,however certain patient populations are at higher risk for recurrent instability and may require surgical intervention for adequate stabilization.Determination of the optimal treatment strategy should be made on a case-by-case basis while weighing both patient specific factors and injury patterns(i.e.,bone loss).The purpose of this review is to describe the relevant anatomical stabilizers of the GHJ,risk factors for recurrent instability including bony lesions,indications for arthroscopic vs open surgical management,clinical history and physical examination techniques,imaging modalities,and pearls/pitfalls of arthroscopic soft-tissue stabilization for anterior glenohumeral instability.

Contrast investigation of multi-slice spiral CT perfusion imaging and pathological findings in VX2 soft-tissue tumor of rabbits

Objective: To perform a contrast investigation of multi-slice spiral CT (MSCT) perfusion imaging and pathological findings in VX2 soft-tissue tumor of rabbits, and discuss the applicative value of multi-slice spiral CT perfusion imaging in soft-tissue tumors. Methods: 8 Newzealand white rabbits were implanted with 0.1 ml VX2 tumor tissue suspension in bilateral proximal thighs. 14 days and 21 days later, CT plain scan and perfusion scan were performed on these rabbits respectively, then the images were transmitted to AW4.0 workstation, the functional maps and perfusion parameters including blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface (PS) were computed and analyzed. Subsequently, the rabbits were sacrificed, the tumors of which were taken out for pathological examination. The correlation between MSCT functional parametric images and pathological findings was analyzed. Results: All the values of BF, BV and PS of VX2 soft-tissue tumors were obviously higher while the MTT-values were lower than those of the normal muscular tissues significantly (P<0.001). Conclusion: Multi-slice spiral CT perfusion imaging is an accurate, convenient and relatively safe functional imaging technique, which can give a quantitative assessment to blood perfusion and angiogenesis of soft-tissue tumors.

The Importance of the Multidisciplinary Approach to Surgical Treatment of Extremity Soft-Tissue Sarcomas

Soft tissue sarcomas (STS) are rare neoplasm with frequencies around 1% of all neoplasms. Although it consists of a high heterogeneous group of tumors, surgery is the mean treatment. The STS surgery is still challenging and complex procedure is usually required: this is because STS requires different types of resection and reconstruction due to various tissue-commitments (nerve, arteries, skin and muscle). So, a multidisciplinary team must be prepared for STS approach to obtain the maximum local control and a limited extremity functional impairment. We, here, showing our experience, wish to introduce some technical contrivances in STS surgery, with special reference to tissue reconstruction. This may illustrate the necessity of a multidisciplinary team approach in this surgery.

Analgesic Effect of Sinew Acupuncture for Patients with Soft-Tissue Injuries: A Pilot Trial

Objective: To investigate the immediate analgesic effect of sinew acupuncture for patients with soft-tissue injuries (STIs). Methods: Two hundreds eligible adult patients suffering from STIs were recruited and received sinew acupuncture with flexible treatment schedules. The number of treatment sessions was pragmatically decided by each patient on the basis of their pain relief. The outcome measurement was the change of pain rating in the Visual Analogue Scale (VAS) during the first 5 sessions. The adverse effect was also observed. Results: Of the 200 patients recruited, 7 were excluded due to incomplete data. In total, 888 sinew acupuncture treatments were administered to patients at 14 injury sites (including head, neck, shoulder, arm, chest, elbow, wrist, hand, waist and hip, knee, thigh, calf, ankle, and foot) where pain was felt. Compared with the baseline, the VAS rating after the first and last treatments were both significantly reduced at all the injury sites (P<0.01). The VAS rating was also significantly reduced after each session of treatment in the first five sessions (P<0.01). No serious adverse effect was observed. Conclusion: Sinew acupuncture had not only an immediate analgesic effect for STIs, but also an accumulated analgesic effect during the first 5 treatment sessions.

Metastatic melanoma misdiagnosed as lipoma manifesting as a subcutaneous soft-tissue mass

To the Editor:Metastatic melanoma is a fatal disease with rapid systemic dissemination and a 5-year survival rate of about 1 7%.[1] More than half of primary metastases involve the skin as nodal,subcutaneous,or distant metastasis.[2] Cutaneous metastases of melanoma occur relatively frequently and can arise in early-or late-stage disease,with a variable clinical appearance and pattern distribution.[3] We describe herein a patient with a large subcutaneous nodule on the arm that we initially diagnosed as a lipoma.After obtaining further clinical history and reviewing the pathologic findings after excision,the nodule was determined to represent metastatic melanoma.

Soft-tissue management and reconstruction of lower-extremity trauma

Soft-tissue management and subsequent salvage of the lower extremity following trauma has long presented difficult challenges to the plastic surgeon.Trauma to the lower extremity can produce long-term sequelae consisting of psychological trauma,functional deficits,and increased costs to the healthcare system.Avoiding incorrect management is important,and is compounded by the fact that few guidelines exist on appropriate treatment and patient counseling.This study aims to describe the authors’experience at a large limb salvage center in order to further delineate management strategies.

First line anlotinib plus liposomal doxorubicin for locally advanced or metastatic soft tissue sarcoma:A prospective,single-arm trial

Objective:To examine the efficacy and safety of anlotinib as first-line therapy to treat locally advanced or metastatic soft-tissue sarcoma.Methods:This is a single-arm trial.Treatment-naïve patients(≥14 years)with locally advanced or metastatic soft tissue sarcoma were eligible.Each treatment cycle lasted for 3 weeks,and included liposomal doxorubicin(40-50 mg/m^(2))on day 1 and anlotinib(12 mg)on days 8-21.Starting from the 9th cycle,treatment consisted of only anlotinib.Treatment continued until disease progression or intolerable toxicities.The primary efficacy end point was progression-free survival(PFS).Results:Eight patients were enrolled between July 25,2019 and January 8,2020.The median number of treatment cycles was 5.5.Within 5.9 months median follow-up,PFS events occurred in 4(4/8,50%)patients.The median PFS was 11.3 months and the 6-month PFS rate was 56%.No patients attained complete response and 2 patients(fibrosarcoma,1 patient and undifferentiated pleomorphic sarcoma,1 patient)achieved partial response.Three patients(fibrosarcoma,2 patients and synovial sarcoma,1 patient)had stable disease.The objective response rate was 25%(2/8)for the study population,and the disease control rate was 75%(6/8).No new safety concerns emerged.Conclusions:Anlotinib plus liposomal doxorubicin demonstrated antitumor activities in previously untreated locally advanced or metastatic soft tissue sarcomas.Due to the small sample size,further investigations with a larger population should be undertaken to confirm the study findings.

A Polydisperse Sphere Model Describing the Propagation of Light in Biological Tissue

A polydisperse sphere model with the complex refractive index is employed to describe the propagation of light in biological tissue. The scattering coefficient, absorption coefficient and scattering phase function are calculated. At the same time, the inverse problem on retrieving the particles size distribution, imaginary part of the refractive index and number density of scatterers is investigated. The result shows that the retrieval scheme together with the Chahine algorithm is effective in dealing with such an inverse problem. It is also clarified that a group of parameters including the scattering coefficient, absorption coefficient and phase function are associated with another group including the refractive index, particle size distribution and number density of scatterers, which is a problem described in two different ways and the anisotropy factor is not an independent variable, but is determined by the phase function.

Total knee arthroplasty in Ranawat Ⅱ valgus deformity with enlarged femoral valgus cut angle:A new technique to achieve balanced gap

BACKGROUND Nearly 10%of patients undergoing primary total knee arthroplasty(TKA)have valgus deformity(VD)of the knee.For severe VD of the knee,a more lateral structural release is needed to achieve balance between medial and lateral space and neutral femorotibial mechanical axis(FTMA),which is challenging and technical.AIM To introduce a new surgical technique of resection,soft tissue release,and FTMA for Ranawat type-Ⅱ VD with a 5-year follow-up.METHODS A retrospective study was conducted on patients who underwent TKA from December 2011 to December 2014.Hip-knee-ankle(HKA),range of motion(ROM),Oxford knee score(OKS),and knee society score(KSS)were used to assess the joint activity of patients in the new theory TKA group(NT-TKA)and were compared with those of the conventional TKA group(C-TKA).RESULTS A total of 103 people(103 knees)were included in this study,including 42 patients with an average follow-up period of 83 mo in the C-TKA group and 61 patients with an average follow-up period of 76 mo in the NT-TKA group.Six patients had constrained prosthesis,one had common peroneal nerve injury,and two had joint instability in the C-TKA group,but none of these occurred in the NT-TKA group.There were significant statistical differences in constrained prosthesis usage and complications between the groups(P=0.002 and P=0.034,respectively).The KSS at 1 mo post-operation for the C-TKA and NT-TKA groups were 11.2±3.8 and 13.3±2.9,respectively,with a significant difference(P=0.007).However,the data of HKA,ROM,OKS KSS,and prosthesis survival rate were insignificant(P>0.05)in both the preoperative and follow-up periods.CONCLUSION Adopting 5°-7°valgus cut angle for VD and sacrificing 2°neutral FTMA for severe VD which cannot be completely corrected during TKA can reduce the need for soft tissue release,maintain early joint stability,reduce the use of constrained prostheses,and minimize postoperative complications.

An Extensively Drug Resistant Acinetobacter baumannii from Soft Tissue Isolated in a Hospital in Senegal

Emerging and rapidly spreading multidrug resistant bacteria constitute a rising public health concern worldwide. Acinetobacter baumannii is one of these bacteria that cause different infections including pneumonia, bacteremia, meningitis, soft-tissue, and urinary tract infections, and are associated with high mortality and economic burden. We present a case of a 43-year-old woman, admitted at the department of orthopedics, regional hospital of Ourossogui, North-East of Senegal for soft-tissue injuries. Initially diagnosed with Yersinia pestis infection, the patient was well managed before being released. Supplementary sampling for confirmatory tests allowed the detection of an extensively drug-resistant Acinetobacter baumannii clone.

Development and accuracy of artificial intelligence-generated prediction of facial changes in orthodontic treatment:a scoping review

Artificial intelligence(AI)has been utilized in soft-tissue analysis and prediction in orthodontic treatment planning,although its reliability has not been systematically assessed.This scoping review was conducted to outline the development of AI in terms of predicting soft-tissue changes after orthodontic treatment,as well as to comprehensively evaluate its prediction accuracy.Six electronic databases(PubMed,EBSCOhost,Web of Science,Embase,Cochrane Library,and Scopus)were searched up to March 14,2023.Clinical studies investigating the performance of AI-based systems in predicting post-orthodontic soft-tissue alterations were included.The Quality Assessment of Diagnostic Accuracy Studies-2(QUADAS-2)and Joanna Briggs Institute(JBI)appraisal checklist for diagnostic test accuracy studies were applied to assess risk of bias,while the Grading of Recommendation,Assessment,Development,and Evaluation(GRADE)assessment was conducted to evaluate the certainty of outcomes.After screening 2500 studies,four non-randomized clinical trials were finally included for full-text evaluation.We found a low level of evidence indicating an estimated high overall accuracy of AI-generated prediction,whereas the lower lip and chin seemed to be the least predictable regions.Furthermore,the facial morphology simulated by AI via the fusion of multimodality images was considered to be reasonably true.Since all of the included studies that were not randomized clinical trials(non-RCTs)showed a moderate to high risk of bias,more well-designed clinical trials with sufficient sample size are needed in future work.

Prevalence and associated factors of intra-articular lesions in acute ankle fractures evaluated by arthroscopy and clinical outcomes with minimum 24-month follow-up

Background:Acute ankle fractures can lead to high rate of concomitant intra-articular lesions which may compromise clinical results.The purpose of this study was to evaluate the Prevalence of concomitant intra-articular lesions in acute ankle fractures with arthroscopy.We also sought to analyze the relationship between intra-articular lesions and the fracture type,as well as the severity of the fracture.Methods:It was a retrospective cohort study.From April 2014 to December 2015,we have chosen arthroscopy-assisted open reduction and internal fixation (AORIF) for the treatment of unstable acute ankle fractures.All concomitant intra-articular lesions were assessed and documented carefully and prospectively,such as ligament injuries,osteochondral lesions,and tibiofibular syndesmosis injuries.All fractures were classified according to the Lauge-Hansen classification system.The American Orthopedic Foot and Ankle Society's (AOFAS) ankle-hindfoot scale was used to assess post-operative function.Statistical comparisons between the intra-articular lesions,the fracture type,and the severity of the presenting fracture were performed using a Chi-squared analysis.Results:Data of 36 patients were analyzed in the study,including 23 supination-type fractures and 13 pronation-type fractures.The incidence of tibiofibular syndesmosis injuries,chondral lesions,and loose bodies were 92%,72%,and 39%,respectively.Avulsion fractures of the anterior tibiofibular syndesmosis were more commonly found in supination-type fractures than pronation-type fracture (45% vs.15%,x2 =5.78,P =0.02),which would cause mechanical blocking in the anterior portion of the ankle.On the contrary,chondral lesions were more commonly found in the more severe fractures than mild fractures (86% vs.53%,x2 =4.57,P =0.03).A mean 41.7 months (range,33.0-51.0 months) of follow-up was achieved.A mean AOFAS's ankle-hindfoot scale was 96.9,and 97.2% of the patients were satisfied with the procedure.Conclusions:Acute ankle fractures have a high incidence of concomitant intra-articular lesions.Avulsion fractures of the anterior tibiofibular syndesmosis are more commonly found in supination-type fractures.Chondral lesions are related to the severity of the fractures,but not with the classification of the fractures.AORIF can be one reliable solution in dealing with the associated injuries seen with acute ankle fractures.

Contemporary reconstruction after complex facial trauma

Complex facial trauma requires complex repair and solutions.This process is challenging for the surgeon who seeks to manage the expectations of the patient and family while achieving the best possible result.Historically,the use of pedicled flaps,and then free tissue transfer,were the primary techniques utilized.Advancements in soft-tissue reconstruction,such as perforator flaps and pre-expanded and prefabricated flaps,allow refinement of the soft-tissue reconstruction process to create the best initial soft-tissue coverage.The advent of contemporary technologies,such as virtual surgical planning,stereolithography and customized implants and plates,facilitates a tailored approach to the patient’s reconstructive needs for precise bony reconstruction.When surgical and technological techniques are combined in complementary multistage reconstructions,better reconstructive and aesthetic outcomes are achievable than ever before.In this review,the authors present a summary of the management of complex facial trauma based on the senior author’s broad experience.Initial management and contemporary reconstructive techniques and technology to provide optimal outcomes are reviewed.A case series of complex facial traumas and their reconstructive process is also presented to demonstrate how complementary staged procedures can yield an optimal result.We believe the reconstructive surgeon managing complex facial trauma should strive to incorporate contemporary technologies and techniques into their armamentarium to provide the best patient care.

Characteristics and prognosis of embryonal rhabdomyosarcoma in children and adolescents:An analysis of 464 cases from the SEER database

Importance:As the most common subtype of pediatric rhabdomyosarcoma(RMS),the prognosis of embryonal RMS has rarely been investigated solely.Objective:To perform a population-based study to characterize the prognosis of embryonal RMS in children and adolescents.Methods:Demographic and clinical features were retrospectively evaluated in selected patients with embryonal RMS registered in the Surveillance,Epidemiology,and End Results(SEER)program from 1988 to 2016.Survival curves were compared using the log-rank test.A multivariate Cox proportional hazards model was developed to assess the impact of each factor on the overall survival.A nomogram was constructed based on the results of Cox regression model.Results:A total of 464 patients were included in the analysis,among which 64.6%were male and 70.2%were white patients.About 38.6%and 26.3%of the patients were at 1-4 years and 5-9 years,respectively.Cox analysis showed that patients at age group 5-9 years had the lowest risk of mortality(hazard ratio[HR],0.277;95%confidential interval[CI],0.123-0.620),compared with patients diagnosed at less than 1-year-old,and age group 1-4 years had the second-best prognosis.Patients having distant tumors had significantly higher mortality risk(HR,4.842;95%CI,2.804-8.362)than the patients with localized tumor.Compared with receiving no surgery or radiotherapy,receiving any combination of surgery and radiotherapy would lower the risk of mortality significantly(for surgery without radiotherapy:HR,0.418;for radiotherapy without surgery:HR,0.405;and for surgery plus radiotherapy:HR,0.410).Interpretation:Age,stage at diagnosis,and treatment received were found to be the most important predictors of the overall survival of pediatric embryonal RMS.

Free tissue transfer for lower extremity trauma in the pediatric patient

Aim:The utilization of free-tissue transfer secondary to traumatic lower extremity defects in the pediatric population is scarcely described.Factors include microsurgeon inexperience,inadequate center resources,and fear of historically described poor surgical outcomes.The aim of this study is to investigate more recent articles describing free-flap microsurgical reconstruction for these defects.Methods:A systematic review of the literature was conducted through the online databases PubMed,Embase,and Web of Science,examining for articles with at least 20 subjects utilizing free-tissue transfer for soft-tissue defects of the pediatric(aged 18 and younger)lower extremity following traumatic etiology since 2005.Outcomes included flap failure,return to the operating room,and functional status,where available.Results:Seven studies were deemed appropriate for inclusion,with a total of 243 flaps included.Motor vehicle and motorcycle accidents were greater than 75%of total etiology.Most defects involved the foot or ankle(65.1%).In total,perforator flaps compromised the majority of flaps(54%),with the most common being the anterolateral thigh,the scapular/parascapular,and deep inferior epigastric flaps.Less common perforators included the groin flap,tensor fascia lata,radial forearm,lateral arm,and thoracodorsal perforator flap.Muscle-based flaps were less common(46%),with the latissimus dorsi and rectus muscle flaps composing the majority.The most commonly used recipient vessel was the anterior tibialis(49.5%)and posterior tibialis vessels(45.3%).Most studies performed reconstruction within 7-10 days of presentation.There was a cumulative 6.5%flap failure rate.Conclusion:Free tissue transfer for pediatric lower extremity trauma is an important tool that likely leads to powerful outcomes.Recent trends indicate increasing usage of perforator flaps.This study shows that based on existing data,free flap utilization for pediatric patients is an adequate modality for repair,and may warrant greater consideration moving forward.