Association of DNA methylation/demethylation with the functional outcome of stroke in a hyperinflammatory state

Inflammation is closely related to stroke prognosis, and high inflammation status leads to poor functional outcome in stroke. DNA methylation is involved in the pathogenesis and prognosis of stroke. However, the effect of DNA methylation on stroke at high levels of inflammation is unclear. In this study, we constructed a hyperinflammatory cerebral ischemia mouse model and investigated the effect of hypomethylation and hypermethylation on the functional outcome. We constructed a mouse model of transient middle cerebral artery occlusion and treated the mice with lipopolysaccharide to induce a hyperinflammatory state. To investigate the effect of DNA methylation on stroke, we used small molecule inhibitors to restrain the function of key DNA methylation and demethylation enzymes. 2,3,5-Triphenyltetrazolium chloride staining, neurological function scores, neurobehavioral tests, enzyme-linked immunosorbent assay, quantitative reverse transcription PCR and western blot assay were used to evaluate the effects after stroke in mice. We assessed changes in the global methylation status by measuring DNA 5-mc and DNA 5-hmc levels in peripheral blood after the use of the inhibitor. In the group treated with the DNA methylation inhibitor, brain tissue 2,3,5-triphenyltetrazolium chloride staining showed an increase in infarct volume, which was accompanied by a decrease in neurological scores and worsening of neurobehavioral performance. The levels of inflammatory factors interleukin 6 and interleukin-1 beta in ischemic brain tissue and plasma were elevated, indicating increased inflammation. Related inflammatory pathway exploration showed significant overactivation of nuclear factor kappa B. These results suggested that inhibiting DNA methylation led to poor functional outcome in mice with high inflammation following stroke. Further, the effects were reversed by inhibition of DNA demethylation. Our findings suggest that DNA methylation regulates the inflammatory response in stroke and has an important role in the functional outcome of hyperinflammatory stroke.

Early screening for post-stroke depression and its effect on functional outcomes, quality of life, and mortality: A meta-analysis

BACKGROUND Post-stroke depression(PSD)is a common and debilitating condition affecting stroke survivors,significantly impacting their recovery and overall quality of life.AIM To assess the effects of early PSD screening on functional outcomes,quality of life,and mortality.METHODS From an initial pool of 1065 articles,6 studies met the inclusion criteria and were selected for analysis.Functional outcomes were measured using the functional independence measure(FIM).RESULTS The analysis revealed a significant improvement in FIM scores for a PSD scree-ning group compared to controls[standardized mean difference(SMD)=8.90,95%confidence interval(CI):4.65-13.15,P<0.01].Quality of life was assessed using the Stroke-Specific Quality of Life Scale,with the screening group showing significantly higher scores(SMD=20.83,95%CI:15.27-26.38,P<0.01).Mortality analysis indicated a reduction in five-year mortality rates for the PSD screening group.CONCLUSION Early PSD screening enhances functional recovery,improves quality of life,and reduces mortality rates in stroke survivors.Thus,integrating PSD screening into routine stroke care improves long-term outcomes for patients.

Functional Outcomes of Adult Tibia Shaft Fractures Treated with Solid Intramedullary Nails versus Hollow Nails: A Systematic Review

Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current review aims to compare the outcomes of adult tibia fractures treated with solid nails to those treated with hollow nails. Methods: A search on Scopus, PubMed, and Cochrane Library, using three keywords (Outcome, Tibia shaft fractures, Nail) was conducted in April 2023. Results were compiled and two independent reviewers screened and selected eligible articles After removing duplicates, titles and abstracts were read to exclude ineligible studies. Full-text articles of the remaining papers were read to select eligible studies which were further critically appraised to ascertain their methodological quality. The data extracted from the selected papers were synthesized using a combination of pooling of results, tests of statistical difference (t-test and chi-square) and narrative synthesis methods. Results: A total of 2295 articles were obtained from the databases and citation searching. A total of 9 papers were identified as eligible and included in the review. Findings revealed that there is no statistical difference in the outcomes of tibia fractures treated with either solid or hollow nail groups such as duration of surgery (p = 0.541), rate of delayed and non-union (p = 0.342), and rate of surgical site infections (p = 0.395). Conclusion: Intramedullary nailing of tibia shaft fractures with either solid or hollow nails have similar functional outcomes.

Type 2 diabetes is associated with a worse functional outcome of ischemic stroke

AIM: To assess whether ischemic stroke severity and outcome is more adverse in patients with type 2 diabetes mellitus(T2DM). METHODS: Consecutive patients hospitalized for acute ischemic stroke between September 2010 and June 2013 were studied prospectively(n = 482; 40.2% males, age 78.8 ± 6.7 years). T2 DM was defined as self-reported T2 DM or antidiabetic treatment. Stroke severity was evaluated with the National Institutes of Health Stroke Scale(NIHSS) score at admission. The outcome was assessed with the modified Rankin scale(m RS) score at discharge and with in-hospital mortality. Adverse outcome was defined as m RS score at discharge ≥ 2 or in-hospital death. The length of hospitalization was also recorded.RESULTS: T2 DM was present in 32.2% of the study population. Patients with T2 DM had a larger waist circumference, higher serum triglyceride and glucose levels and lower serum high-density lipoprotein cholesterol levels as well as higher prevalence of hypertension, coronary heart disease and congestive heart failure than patients without T2 DM. On the other hand, diabetic patients had lower low-density lipoprotein cholesterol levels and reported smaller consumption of alcohol than non-diabetic patients. At admission, the NIHSS score did not differ between patients with and without T2DM(8.7 ± 8.8 and 8.6 ± 9.2, respectively; P = NS). At discharge, the m RS score also did not differ between the two groups(2.7 ± 2.1 and 2.7 ± 2.2 in patients with and without T2 DM, respectively; P = NS). Rates of adverse outcome were also similar in patients with and without T2DM(62.3% and 58.5%, respectively; P = NS). However, when we adjusted for the differences between patients with T2 DM and those without T2 DM in cardiovascular risk factors, T2 DM was independently associated with adverse outcome [relative risk(RR) = 2.39; 95%CI: 1.21-4.72, P = 0.012]. Inhospital mortality rates did not differ between patients with T2 DM and those without T2DM(9.0% and 9.8%, respectively; P = NS). In multivariate analysis adjusting for the difference in cardiovascular risk factors between the two groups, T2 DM was again not associated with in-hospital death. CONCLUSION: T2 DM does not appear to affect ischemic stroke severity but is independently associated with a worse functional outcome at discharge.

Serum Gamma-glutamyl Transferase Levels Predict Functional Outcomes after Aneurysmal Subarachnoid Hemorrhage

Objective We aim to explore the potential association between serum gamma-glutamyl transferase levels and functional outcome after aneurysmal subarachnoid hemorrhage in a Chinese population. Methods A total of 386 aneurysmal subarachnoid hemorrhage patients were included in the study from September 2007 to February 2015. Baseline serum gamma-glutamyl transferase levels and 6-month follow-up functional outcomes were determined. A poor outcome was defined as a modified ranking scale score of ≥ 3. The multivariable logistic model was used to analyze the relationship between serum gamma-glutamyl transferase and clinical outcomes after aneurysmal subarachnoid hemorrhage. Results The adjusted poor outcome rates of patients with gamma-glutamyl transferase levels of 〈 30 U/L, 30-50 U/L and ≥ 50 U/L were 16.7%, 19.6%, and 34.4%, respectively （P 〈 0.01）. The age-sex and multivariable adjusted odds ratios （95% confidence intervals） of poor prognosis comparing the top group （≥ 50 U/L） with the lowest group （〈 30 U/L） were 5.76 （2.74-12.13）, 6.64 （2.05-21.52）, and 6.36 （1.92-21.02）. A significant linear trend existed between gamma-glutamyl transferase level and aneurysmal subarachnoid hemorrhage prognosis. This association was also observed among nondrinkers. Conclusion Patients with higher gamma-glutamyl transferase levels were more likely to have a poor prognosis. Serum gamma-glutamyl transferase can be considered to be an independent predictor of functional outcomes after aneurysmal subarachnoid hemorrhage.

Functional Outcomes of Decompressive Hemicraniectomy for Treatment of Malignant Infarctions of the Middle Cerebral Artery

Introduction: Malignant middle cerebral artery (MCA) infarction is a devastating entity that is associated with up to 80% mortality. Decompressive Hemicraniectomy has been utilized to treat brain swelling and mass effect secondary to these infarctions in an attempt to improve functional outcome. Aim: To evaluate the functional outcome of decompressive hemicraniectomy in management of malignant MCA infarctions. Methods: The study included 30 patients with malignant MCA infarctions operated upon by decompressive hemicraniectomy and duroplasty with pericranium or fascia lata graft in the period from June 2016 to January 2019. Pre-operative neurological condition, associated morbidity, location and extent of the infarction were assessed. Surgery was performed within 48 hours of the onset of stroke or 12 hours within deterioration of conscious level. Pre-operative CT scan as well as sequential post-operative CT was done. Functional outcome was assessed by the modified Rankin Scale (mRS) at the time of discharge and 3 months following surgery. Results: The study included 18 males and 12 females with a mean age of 54.7 years. The pre-operative GCS was <8 (5 - 7) in 11 patients and 8 or higher (8 - 13) in 19 patients. Good functional outcome (mRS 0 - 3) was achieved in 13 (43.3%) cases while poor outcome (mRS 4 - 5) occurred in 8 (26.7%) cases and mortality (mRS 6) occurred in 9 (30%) cases. Conclusion: Decompressive hemicraniectomy improves functional outcome in cases of malignant MCA infarction. Pre-operative GCS, age, volume of infarction, degree of midline shift, timing of surgery and associated morbidity are the most important factors affecting the outcome.

Functional Outcomes of Limb Salvage Surgery in Patients with Giant Cell Tumor of Bone of the Lower Extremities: A Retrospective Study

Giant cell tumor of the bone(GCTB)is a benign,locally aggressive neoplasm that is relatively rare,with a propensity to result in progressive bone destruction,and is associated with a high risk of recurrence.There is no widely held consensus regarding its ideal treatment.Worldwide,there are varying techniques ranging from intralesional curettage to resection of the lesion,supplemented with combinations of numerous adjuncts and fillers,depending on the resected amount and integrity of bone,as well as the preference of the surgeon.This was a cross-sectional study that included 20 patients who underwent limb salvage surgery for giant cell tumor of the bone of the lower extremities from January 2009 to February 2020 at two tertiary hospitals.The mean follow-up period was 37.3 months(SD=2.84).The extended curettage(EC)group had a mean Musculoskeletal Tumor Rating Scale(MSTS)score of 28.18(SD=7.51)which is considered as an excellent outcome,while the resection(RS)group had an mean MSTS score of 19.67(SD=11.02),which is considered as a good outcome.EC resulted to a total of eight complications(47%),while RS had one complication(33%).Prevalence of recurrence was noted to be 11.75%among those who underwent EC,while no recurrence was noted among those in the RS group.Use of bone cement as a filler was noted to have less recurrence as compared with the use of bone grafts,however were both were noted to result in excellent functional outcomes.Despite the prevalence of complications and recurrence of GCTB of the salvaged extremity in those who underwent EC,there is still report of excellent functionality.It is hence important to disclose all these possible outcomes and to stress the importance of compliance to follow-up for monitoring of these events.

Achilles tendon thickening does not affect elasticity and functional outcome after surgical repair of Achilles rupture:A retrospective study

Purpose:Previous studies have confirmed that Achilles tendon occurs Achilles thickening after repair surgery of the rupture.Although this mechanism has been elucidated in the laboratory,there are few reports on its impact on clinical function.We designed a retrospective study to investigate the Achilles thickening after Achilles tendon rupture repair and its correlation between the elasticity and postoperative function.Methods:In this retrospective analysis,patients who underwent surgical treatment for acute Achilles tendon rupture from April 2016 to April 2020 were included.All the patients were regularly followed up at 3 months,1 year,and 2 years after surgery.American Orthopaedic Foot Ankle Surgeon(AOFAS)scale and Leppilahti score were used to evaluate functional outcomes.Achilles elasticity was measured by ultrasound shear wave of elasticity.Achilles thickening was calculated as maximal transverse and longitudinal diameter in cross-sectional plane of magnetic resonance scan.Sample t-tests was used for different follow-up periods.Correlation between Achilles thickening and other factors were analyzed using Pearson's method.p<0.05 indicates a statistically significant difference.Results:AOFAS scale and Leppilahti score at 1 year were significantly higher than at 3 months postoperatively(both p<0.001).These functional scales were also improved at 2-year follow-up significantly(both p<0.001).The dorsiflexion difference showed gradually recovery in each follow-up period(t=-17.907,p<0.001).The elasticity of the Achilles appeared to continuously decreases during the postoperative follow-up period in all position sets(p<0.001).In thickening evaluation,the cross-sectional area of the thickest plane of Achilles was significantly higher at 1 year postoperatively(310.5±25.2)mm^(2)than that at 3 months postoperatively((278.0±26.2)mm^(2),t=-8.219,p<0.001)and became thinner in 2-year magnetic resonance scan((256.1±15.1)mm^(2),t=16.769,p<0.001).The correlations between Achilles thickening,elasticity,and functional outcome did not show statistical significance(p>0.05)in every follow-up period.Conclusion:Achilles tendon thickens after surgery in the 1st year,but begins to gradually return to thinning about 2 years after surgery.There was no significant correlation between the increase and decrease of thickening and the patients'clinical function scores,Achilles elasticity,and bilateral ankle dorsiflexion difference.

Impaired Cognition and Stroke Rehabilitation Outcomes: Are They Related?

Background: Stroke survivors who exhibit impaired cognition at admission to inpatient rehabilitation may experience participation challenges and poorer functional outcomes than those without impaired cognition. Differences in functional outcomes between stroke survivors with and without impaired cognition may be attributed to age, level of cognitive impairment, and severity of stroke. Materials and Methods: A retrospective secondary data analysis was conducted using health-related administrative data acquired from a Southwestern Ontario hospital’s stroke rehabilitation database. The aim was to explore potential linkages between post-stroke impaired cognition and functional gains, rehabilitation stays, and living settings after discharge from rehabilitation. Results: An aggregate sample of 393 males and 314 females subclassified as experiencing mild, moderate, and severe stroke was analyzed. At inpatient rehabilitation admission, 21.5% (n = 152) of these patients had no impaired cognition, 33.7% (n = 238) had mild impaired cognition, 22.2% (n = 157) had moderate impaired cognition, and 22.6% (n = 160) had severe impaired cognition. Cognitively impaired stroke patients were significantly (p 0.001) older, had (mostly) moderate to severe stroke with significantly (p = 0.012) more moderate cognitive impairment, had significantly (p 0.001) longer rehabilitation stays, and a high propensity for being discharged to longer-term care facilities compared to non-cognitively impaired patients. Conclusion: Presence of significant dissimilarity in rehabilitation stays and post-discharge destinations among stroke survivors with and without cognitive impairment is attributed to the age of the patient, level of cognitive impairment, and rigorous rehabilitation interventions.

Predictors of functional outcome after hanging injury

Purpose： Suicide becomes a serious problem in today＇s society and hanging is a common method of suicide. We want to find the factors which can predict the final functional outcomes of these cases. Methods： All patients who presented to Accident and Emergency Department （ED） of the National Cheng Kung University Hospital from 1st January 2005 to 31th December 2013 with a hanging injury were included in this study. All cases were divided into good outcome group and bad outcome group according to Glasgow Outcome Scale （GOS）. Data was analyzed by Mann-Whitney test and chi-square test. Results： Glasgow Coma Scale （GCS） 〈 3, pupil dilation and no pupillary light reflex both at the scene and ED were the factors to indicate poor functional outcome. Out-hospital cardiac arrest （OHCA）, acidosis （pH 〈 Z2） and the need for intubation once arriving at ED were also related to poor functional outcome. OHCA cases all had poor functional outcome, Conclusion： GCS, pupil size, pupiUary light reflex, OHCA and acidosis are useful as prognostic factors. GCS= 3 lead to a very poor outcome. However, the functional outcome seems good in patients with GCS〉3. There parameters can help to predict the outcome before treatment.

Trifecta Outcomes of Screening Detected and Patients with Lower Urinary Tract Symptoms after Open Radical Prostatectomy for Localized Prostate Cancer

Background: Many studies have reported on trifecta outcomes after radical prostatectomy. There is however paucity of studies that compares the trifecta outcome between screen detected and patients presenting with lower urinary symptoms with localized prostate cancer after radical prostatectomy. This study compares the trifecta outcomes between these two groups after an open retropubic radical prostatectomy. Methodology: This is a retrospective study, on the trifecta outcomes (urinary continence, erectile function, and cancer control) of consecutive patients that had open radical retropubic prostatectomy for localized prostate cancer by a single surgeon. Patients were grouped into screen detected and presentation with lower urinary symptoms or retention of urine. The parameters considered were the age of the patients, the total prostate specific antigen (tPSA) at presentation, the clinical T stage, the Gleason score of prostate biopsies, the risk categories using the D’Amico risk groups and the trifecta outcomes after the procedure. Results: In all, 119 patients met the criteria for inclusion. The median follow up was 63.5 months (range 12 - 156 months). Of these 40.3% of the patients were diagnosed through screening with elevated PSA while 59.7% had presented with symptoms of lower urinary tract obstruction. The mean age for the patients was 60.8 ± 6.5 years, median PSA 12.6 ng/ml (IQR 8.6 - 19.7) and median prostate weight of 50.0 (IQR 40.0 - 60 g). The urinary continence rate after the procedure was 93.3%, erection rate of 81.5%, cancer control rate of 71.4% and trifecta achieved in 57.1%. Comparing the screening and the symptomatic cases, the urinary continence rate was 91.7% vrs 94.3%;erectile function rate was 79.2% vrs 83.1%;cancer control 68.8% vrs 73.2% and trifecta achieved in 58.3% vrs 56.3%. There was no statistically significant difference between the two groups in terms of urinary continence p = 0.564, erection function p = 0.588, cancer control p = 0.595, and achieving trifecta p = 0.829. Conclusion: Patients with localized prostate cancer presenting with lower urinary symptoms compared to screen detected patients have similar outcomes in terms of urinary Continence, erectile function, cancer control and trifecta after open radical retropubic prostatectomy.

Mesenchymal stem cell-derived extracellular vesicles as a cell-free therapy for traumatic brain injury via neuroprotection and neurorestoration

Traumatic brain injury is a serious and complex neurological condition that affects millions of people worldwide.Despite significant advancements in the field of medicine,effective treatments for traumatic brain injury remain limited.Recently,extracellular vesicles released from mesenchymal stem/stromal cells have emerged as a promising novel therapy for traumatic brain injury.Extracellular vesicles are small membrane-bound vesicles that are naturally released by cells,including those in the brain,and can be engineered to contain therapeutic cargo,such as anti-inflammatory molecules,growth factors,and microRNAs.When administered intravenously,extra cellular vesicles can cross the blood-brain barrier and deliver their cargos to the site of injury,where they can be taken up by recipient cells and modulate the inflammatory response,promote neuroregeneration,and improve functional outcomes.In preclinical studies,extracellular vesicle-based therapies have shown promising results in promoting recove ry after traumatic brain injury,including reducing neuronal damage,improving cognitive function,and enhancing motor recovery.While further research is needed to establish the safety and efficacy of extra cellular vesicle-based therapies in humans,extra cellular vesicles represent a promising novel approach for the treatment of traumatic brain injury.In this review,we summarize mesenchymal ste m/stromal cell-de rived extracellular vesicles as a cell-free therapy for traumatic brain injury via neuroprotection and neurorestoration and brainderived extracellular vesicles as potential biofluid biomarkers in small and large animal models of traumatic brain injury.

Current status and future perspectives on stem cell transplantation for spinal cord injury

BACKGROUND Previous assessments of stem cell therapy for spinal cord injuries(SCI)have encountered challenges and constraints.Current research primarily emphasizes safety in early-phase clinical trials,while systematic reviews prioritize effectiveness,often overlooking safety and translational feasibility.This situation prompts inquiries regarding the readiness for clinical adoption.AIM To offer an up-to-date systematic literature review of clinical trial results concerning stem cell therapy for SCI.METHODS A systematic search was conducted across major medical databases[PubMed,Embase,Reference Citation Analysis(RCA),and Cochrane Library]up to October 14,2023.The search strategy utilized relevant Medical Subject Heading(MeSH)terms and keywords related to"spinal cord","injury","clinical trials","stem cells","functional outcomes",and"adverse events".Studies included in this review consisted of randomized controlled trials and non-randomized controlled trials reporting on the use of stem cell therapies for the treatment of SCI.RESULTS In a comprehensive review of 66 studies on stem cell therapies for SCI,496 papers were initially identified,with 237 chosen for full-text analysis.Among them,236 were deemed eligible after excluding 170 for various reasons.These studies encompassed 1086 patients with varying SCI levels,with cervical injuries being the most common(42.2%).Bone marrow stem cells were the predominant stem cell type used(71.1%),with various administration methods.Follow-up durations averaged around 84.4 months.The 32.7%of patients showed functional improvement from American spinal injury association Impairment Scale(AIS)A to B,40.8%from AIS A to C,5.3%from AIS A to D,and 2.1%from AIS B to C.Sensory improvements were observed in 30.9%of patients.A relatively small number of adverse events were recorded,including fever(15.1%),headaches(4.3%),muscle tension(3.1%),and dizziness(2.6%),highlighting the potential for SCI recovery with stem cell therapy.CONCLUSION In the realm of SCI treatment,stem cell-based therapies show promise,but clinical trials reveal potential adverse events and limitations,underscoring the need for meticulous optimization of transplantation conditions and parameters,caution against swift clinical implementation,a deeper understanding of SCI pathophysiology,and addressing ethical,tumorigenicity,immunogenicity,and immunotoxicity concerns before gradual and careful adoption in clinical practice.

Proximal fibular osteotomy:Systematic review on its outcomes

BACKGROUND The morbidity and burden of knee osteoarthritis affecting millions of lives worldwide has created a constant pursuit in finding the ideal treatment for knee osteoarthritis.There has been a paradigm shift in the surgical treatment of osteoarthritis ever since the initial description of Volkmann’s tibial osteotomy.This review focuses on one such recent procedure,the proximal fibular osteotomy(PFO)for medial compartment knee osteoarthritis.This review encompasses the history,evidence,risk factors,outcomes and technical considerations of PFO.AIM To understand the evidence and its techniques,and whether this could be an alternative solution to the problem of knee osteoarthritis in the developing world.METHODS The phrases“proximal fibular osteotomy”and“knee osteoarthritis”were searched(date of search December 20,2019)on PubMed to identify articles evaluating the biomechanical and clinical outcomes of PFO in patients with knee osteoarthritis.A total of 258 were retrieved.After reviewing the summary of the texts,22 articles written in English were marked for abstract review.Articles that were case studies or cadaver experiments were excluded.The abstracts of the remaining articles were read,and only those that focused on the history,outcomes of case studies and technical considerations of PFO were included in the review.A total of 12 articles were included in this review.RESULTS At least six studies reported improvement in the visual analogue scale(VAS)from the average preoperative VAS score[6.32,95%confidence interval(CI)=(4.05,8.59)]to average postoperative VAS score[1.23,95%CI:(-1.20,3.71)],which was statistically significant.Similarly,the American Knee Society Score(KSS)functional score improved from an average preoperative KSS functional score[43.11,95%CI:(37.83,48.38)]to postoperative KSS functional score[66.145,95%CI:(61.94,70.35)],which was statistically significant.The femorotibial angle improved by around 7º,and the hip knee ankle angle improved by around 6º.CONCLUSION With the existing data,it seems that PFO is a viable option for treating medial joint osteoarthritis in selected patients.Long term outcome studies and progression of disease pathology are some of the important parameters that need to be addressed by use of multicenter randomized controlled trials.

Role of stem cells-based in facial nerve reanimation:A meta-analysis of histological and neurophysiological outcomes

BACKGROUND Treatments involving stem cell(SC)usage represent novel and potentially interesting alternatives in facial nerve reanimation.Current literature includes the use of SC in animal model studies to promote graft survival by enhancing nerve fiber growth,spreading,myelinization,in addition to limiting fibrotic degeneration after surgery.However,the effectiveness of the clinical use of SC in facial nerve reanimation has not been clarified yet.AIM To investigate the histological,neurophysiological,and functional outcomes in facial reanimation using SC,compared to autograft.METHODS Our study is a systematic review of the literature,consistently conducted according to the preferred reporting items for systematic reviews and meta-analyses statement guidelines.The review question was:In facial nerve reanimation on rats,has the use of stem cells revealed as effective when compared to autograft,in terms of histological,neurophysiological,and functional outcomes?Random-effect meta-analysis was conducted on histological and neurophysiological data from the included comparative studies.RESULTS After screening 148 manuscript,five papers were included in our study.43 subjects were included in the SC group,while 40 in the autograft group.The meta-analysis showed no significative differences between the two groups in terms of myelin thickness[CI:-0.10(-0.20,0.00);I^(2)=29%;P=0.06],nerve fibers diameter[CI:0.72(-0.93,3.36);I^(2)=72%;P=0.6],compound muscle action potential amplitude[CI:1.59(0.59,3.77);I^(2)=89%;P=0.15]and latency[CI:0.66(-1.01,2.32);I^(2)=67%;P=0.44].The mean axonal diameter was higher in the autograft group[CI:0.94(0.60,1.27);I^(2)=0%;P≤0.001].CONCLUSION The role of stem cells in facial reanimation is still relatively poorly studied,in animal models,and available results should not discourage their use in future studies on human subjects.

Can immediate postoperative radiographs predict outcomes in pediatric clubfoot?

BACKGROUND The goal of treatment for pediatric idiopathic clubfoot is to enable the patient to comfortably walk on his or her soles without pain.However,currently accepted treatment protocols are not always successful.Based on the abnormal bone alignment reported in this disease,some studies have noted a correlation between radiographic characteristics and outcome,but this correlation remains debated.AIM To assess the correlation between immediately postoperative radiographic parameters and functional outcomes and to identify which best predicts functional outcome.METHODS To predict the outcome and prevent early failure of the Ponseti’s method,we used a simple radiographic method to predict outcome.Our study included newborns with idiopathic clubfoot treated with Ponseti’s protocol from November 2018 to August 2022.After Achilles tenotomy and a long leg cast were applied,the surgeon obtained a single lateral radiograph.Radiographic parameters included the tibiocalcaneal angle(TiCal),talocalcaneal angle(TaCal),talofirst metatarsal angle(Ta1st)and tibiotalar angle(TiTa).During the follow-up period,the Dimeglio score and functional score were examined 1 year after surgery.Additionally,recurring events were reported.The correlation between functional score and radiographic characteristics was analyzed using sample and multiple logistic regression,and the optimal predictor was also identified.RESULTS In total,54 feet received approximately 8 manipulations of casting and Achilles tenotomy at a mean age of 149 days.The average TiCal,TaCal,Ta1st,and TiTa angles were 75.24,28.96,7.61,and 107.31 degrees,respectively.After 12 mo of follow up,we found 66%excellent-to-good and 33.3%fair-to-poor functional outcomes.The Dimeglio score significantly worsened in the poor outcome group(P value<0.001).Tical and TaCal showed significant differences between each functional outcome(P value<0.05),and the TiCal strongly correlated with outcome,with a smaller angle indicating a better outcome,each 1 degree decrease improved the functional outcome by 10 percent.The diagnostic test revealed that a TiCal angle of 70 degrees predicts an inferior functional outcome.CONCLUSION The TiCal,derived from lateral radiographs immediately after Achilles tenotomy,can predict functional outcome at 1 year postoperatively,justifying its use for screening patients who need very close follow-up.

Outcome between Diabetic versus Non-Diabetic Acute Stroke in a Black African Population: A Cohort Study

Background: Post-stroke outcomes are poorer in patients with diabetes mellitus (DM). The aim of this study was to determine the prevalence of DM in acute stroke and to compare the outcome in patients with or without diabetes in a tertiary care hospital in Douala, Cameroon. Methods: This was a hospital-based prospective cohort study included both diabetic and non-diabetic acute stroke patients (ASP). Demographic, clinical profile and outcome data was collected within 3 months of stroke onset. Descriptive statistics, t-test and chi square test used for comparisons while associations between DM and stroke outcomes, were analyzed using multiple logistic regression and survival analysis. Results: Of the 701 ASP included, the overall prevalence of diabetes in stroke was 34.2% (n = 240) while 9.4% (n = 66) had newly diagnosed diabetes. Mortality was significantly elevated amongst patients with diabetes during hospitalization (p = 0.034) and at 3 months post stroke onset (p = 0.004), but on multivariate analysis, diabetes was not an independent predictor of mortality [OR = 0.984;(95% CI: 0.506 - 1.913);p = 0.961)]. On Cox proportional hazards regression model, the risk of dying was about 1.5 times higher amongst the DM patients compared to non-diabetic patients [adjusted HR (95% CI) of 1.502 (1.128 - 2.000);p = 0.005]. Diabetes was not an independent predictor of poor functional outcome within 3 months post stroke. Conclusion: About 1 in 3 ASP had DM on admission. Survival is better in non-diabetes versus diabetes mellitus ASP. DM was associated with high mortality but does not influence the functional outcome of ASP in our setting

Six-year outcomes in neovascular age-related macular degeneration with ranibizumab

AIM： To evaluate the outcomes of （6y ranibizumab therapy in neovascular age-related macular degeneration （AMD）.METHODS： HELIX was a retrospective, observational effectiveness study using medical records of patients treated in three clinics in Belgium. Patients had neovascular AMD and were initially treated with intravitreal ranibizumab （0.5 mg） between November 1, 2007 and October 31, 2008, had （6y of data available, and were treated on an ongoing, as-needed basis. Outcomes included best-corrected visual acuity （BCVA） and central retinal thickness （CRT）.RESULTS： The sample consisted of 88 eyes from 69 patients. Mean age was 76.4±6.5y, most patients were female （62.3%）. Most eyes （62.5%） were treatment-naive, 33 previously treated eyes had received predominantly other anti-vascular endothelial growth factor agents and verteporfin. Mean baseline BCVA was 57.4±12.7 ETDRS letters and CRT was 291.5±86.1 （m. On average, patients received 20.6±11.9 ranibizumab injections over the （6y. Intervals between injections were on average 12.7±16.1wk. Mean change in BCVA from baseline to last observation for the sample was less than one letter （-0.9±17.3 letters）, with an average loss of -3.2±15.6 letters in previously treated eyes versus a gain of 0.6±18.4 letters in treatment-na？ve eyes. When considering a loss of 〈15 letters over 6y as stabilization of disease, 75.9% of all eyes showed a positive （improvement or stabilization） outcome. Mean change in CRT from baseline to last observation for the sample was -26.9±148.4 （m with the greatest reduction observed in treatment-naive eyes.CONCLUSION： This retrospective study of 69 neovascular AMD patients treated for （6y with ranibizumab demonstrates long-term visual stabilization. In light of the natural evolution of the disease, these data confirm that ranibizumab is effective long-term under real-world conditions of heterogeneity of patients, clinicians, and centers.

Open reduction and internal fixation for radial head fractures: A prospective observational study

Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.

Total hip arthroplasty in fused hips with spine stiffness in ankylosing spondylitis

Ankylosing spondylitis(AS)is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function.Functional impairment is significant,with spine and hip involvement,and is predominantly seen in the younger age group.Total hip arthroplasty(THA)for fused hips with stiff spines in AS results in considerable improvement of mobility and function.Spine stiffness associated with AS needs evaluation before THA.Preoperative assessment with lateral spine radiographs shows loss of lumbar lordosis.Spinopelvic mobility is reduced with change in sacral slope from sitting to standing less than 10 degrees conforming to the stiff pattern.Care should be taken to reduce acetabular component anteversion at THA in these fused hips,as the posterior pelvic tilt would increase the risk of posterior impingement and anterior dislocation.Fused hips require femoral neck osteotomy,true acetabular floor identification and restoration of the hip center with horizontal and vertical offset to achieve a good functional outcome.Cementless and cemented fixation have shown comparable long-term results with the choice dependent on bone stock at THA.Risks at THA in AS include intraoperative fractures,dislocation,heterotopic ossification,among others.There is significant improvement of functional scores and quality of life following THA in these deserving young individuals with fused hips and spine stiffness.