Distinction between short-segment Barrett's esophageal and cardiac intestinal metaplasia

AIM： To investigate the roles of mucin histochemistry, cytokeratin 7/20 （CK7/20） immunoreactivity, clinical characteristics and endoscopy to distinguish short- segment Barrett＇s esophageal （SSBE） from cardiac intestinal metaplasia （CIM）. METHODS： High iron diamine/Alcian blue （HID/AB） mucin-histochemical staining and immunohistochemical staining were used to classify intestinal metaplasia （IN） and to determine CK7/20 immunoreactivity pattern in SSBE and CIM, respectively, and these results were compared with endoscopical diagnosis and the positive rate of gastroesophageal reflux disease （GERD） symptoms and H pylori infection. Long-segment Barrett＇ s esophageal and IM of gastric antrum were designed as control. RESULTS： The prevalence of type III IM was significantly higher in SSBE than in CIM （63.33% vs 23.08%, P〈0.005）. The CK7/20 immunoreactivity in SSBE showed mainly Barrett＇s pattern （76.66%）, and the GERD symptoms in most cases which showed Barrett＇ s pattern were positive, whereas H pylori infection was negative. However, the CK7/20 immunoreactivity in CIM was gastric pattern preponderantly （61.54%）, but there were 23.08% cases that showed Barrett＇s pattern. H pylori infection in all cases which showed gastric pattern was significantly higher than those which showed Barrett＇ s pattern （63.83% vs 19.30%, P〈0.005）, whereas the GERD symptoms in gastric pattern were significantly lower than that in Barrett＇s pattern （21.28% vs 85.96%,P〈O.O05）. CONCLUSION： Distinction of SSBE from CIM should not be based on a single method; however, the combination of clinical characteristics, histology, mucin histochemistry, CK7/20 immunoreactivity, and endoscopic biopsy should be applied. Type III IM, presence of GERD symptoms, and Barrett＇s CK7/20 immunoreactivity pattern may support the diagnosis of SSBE, whereas non-type III IM, positive H pylori infection, and gastric CK7/20 immunoreactivity pattern may imply CIM.

Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures

BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.

Magnifying endoscopy for the diagnosis of specialized intestinal metaplasia in short-segment Barrett's esophagus

AIM:To determine whether magnified observation of short-segment Barrett’s esophagus(BE)is useful for the detection of specialized intestinal metaplasia(SIM).METHODS:Thirty patients with suspected short-segment BE underwent magnifying endoscopy up to×80.The magnified images were analyzed with respect to their pit-patterns,which were simultaneously classified into five epithelial types[Ⅰ(small round),Ⅱ(straight),Ⅲ(long oval),Ⅳ(tubular),Ⅴ(villous)]by Endo’s classification.Then,a 0.5%solution of methylene blue(MB)was sprayed over columnar mucosa.The patterns of the magnified image and MB staining were analyzed.Biopsies were obtained from the regions previously observed by magnifying endoscopy and MB chromoendoscopy.RESULTS:Three of five patients with a typeⅤ(villous)epithelial pattern had SIM,whereas 21 patients with a non-typeⅤepithelial patterns did not have SIM.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of pit-patterns in detecting SIM were 100%,91.3%,92.3%,60%and100%,respectively(P=0.004).Three of the 12 patients with positive MB staining had SIM,whereas 14patients with negative MB staining did not have SIM.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of MB staining in detecting SIM were 100%,60.9%,65.4%,25%and100%,respectively(P=0.085).The specificity and accuracy of pit-pattern evaluation were significantly superior compared with MB staining for detecting SIM by comparison with the exact McNemar’s test(P=0.0391).CONCLUSION:The magnified observation of a shortsegment BE according to the mucosal pattern and its classification can be predictive of SIM.

The Importance of Posterior Tibial Slope in TKR: Pre and Post-Operative Measurements in United States Osteoarthritic Patients

Background: Sagittal plane placement of the tibial component in total knee replacement (TKR) has important implications for maximizing the range of flexion motion, allowing collateral ligaments to function more normally, as well as providing ideal compressive loading on the tibial bone-prosthesis interface. This study attempts to quantify the normal posterior tibial slope (PTS) angle pre-operatively and post-operatively in osteoarthritic patients after using a conventional extramedullary tibial resection guide to assess its effectiveness. Methods: Forty-nine primary cementless total knee replacements in 34 osteoarthritic patients were measured radiographically pre-operatively and one year post-operatively to determine the PTS and its effect on range of motion. Lateral X-rays, using the anterior cortical line of the tibia, were employed for all measurements. Results: Pre-operative PTS measured 11.83˚ (range 5˚ - 18˚), while post-operative PTS of implanted tibial components measured 11.30o (range 4˚ - 18˚). The pre-operative range of motion of 112˚ (range 30˚ to 135˚) was improved to 119˚ (range 90˚ to 135˚) post-operatively after 1 year. Conclusions: Anterior tibial shaft referencing using a conventional extramedullary tibial resection guide provides an easy and convenient method for reproducing the anatomical PTS during TKR. This methodology provided improvement in average range of motion from 112˚ pre-operatively to 119˚ post-operatively at one year.

Changes in posterior corneal elevation after small incision lenticule extraction for different myopic diopters

●AIM:To study the changes and effect factors of posterior corneal surface after small incision lenticule extraction(SMILE)with different myopic diopters.●METHODS:Ninety eyes of 90 patients who underwent SMILE were included in this retrospective study.Patients were allocated into three groups based on the preoperative spherical equivalent(SE):low myopia(SE≥-3.00 D),moderate myopia(-3.00 D>SE>-6.00 D)and high myopia(SE≤-6.00 D).Posterior corneal surfaces were measured by a Scheimpflug camera preoperatively and different postoperative times(1wk,1,3,6mo,and 1y).Posterior mean elevation(PME)at 25 predetermined points of 3 concentric circles(2-,4-,and 6-mm diameter)above the best fit sphere was analyzed.●RESULTS:All surgeries were completed uneventfully and no ectasia was found through the observation.The difference of myopia group was significant at the 2-mm ring at 1 and 3mo postoperatively(1mo:P=0.017;3mo:P=0.018).The effect of time onΔPME was statistically significant(2-mm ring:P=0.001;4-mm ring:P<0.001;6-mm ring:P<0.001).The effect of different corneal locations onΔPME was significant except 1wk postoperatively(1mo:P=0.000;3mo:P=0.000;6mo:P=0.001;1y:P=0.001).Posterior corneal stability was linearly correlated with SE,central corneal thickness,ablation depth,residual bed thickness,percent ablation depth and percent stromal bed thickness.●CONCLUSION:The posterior corneal surface changes dynamically after SMILE.No protrusion is observed on the posterior corneal surface in patients with different degrees of myopia within one year after surgery.SMILE has good stability,accuracy,safety and predictability.

Safety and efficacy of posterior approach for resection of spinal meningioma:Impact of dural attachment location

BACKGROUND Spinal meningiomas(SMs)are common benign tumors that are typically treated with surgical resection.The choice of surgical approach may vary depending on the location of dural attachment of the SM,with a posterior approach being the traditional preference.However,there is limited research available on the impact of dural attachment location on outcomes following posterior approach for SM resection.The average age of the included 34 patients’(10 males and 24 females)age was 62.09 years.Mean follow-up duration was 22.65 months.The location of SM was the thoracic spine in 32 cases,with only 2 in the cervical spine.On average,intraoperative blood loss was 520.59 mL,and operating time was 176.76 minutes.Thirty three cases had successful outcomes while only 1 experienced an unexpe-cted outcome.The tumor recurrence rate was 2.9%.After surgery,there were 3 cases of cerebral spinal fluid leakage,1 case of pneumonia,and 1 case of urinary tract infection.Dural attachments were predominantly found dorsal or dorso-lateral(13 cases),followed by ventral or ventrolateral(14 cases),and lateral(7 cases).The outcomes among these subgroups were similar.CONCLUSION The posterior approach for SM resection is safe and effective,yielding comparable surgical and neurological outcomes regardless of the dural attachment location.

DAPK2 promotes autophagy to accelerate the progression of ossification of the posterior longitudinal ligament through the mTORC1 complex

Background:Ossification of the posterior longitudinal ligament(OPLL)is a prevalent condition in orthopedics.While death-associated protein kinase 2(DAPK2)is known to play roles in cellular apoptosis and autophagy,its specific contributions to the advancement of OPLL are not well understood.Methods:Ligament fibroblasts were harvested from patients diagnosed with OPLL.Techniques such as real-time reverse transcriptasepolymerase chain reaction(RT-qPCR)and Western blot analysis were employed to assess DAPK2 levels in both ligament tissues and cultured fibroblasts.The extent of osteogenic differentiation in these cells was evaluated using an alizarin red S(ARS)staining.Additionally,the expression of ossification markers and autophagy markers was quantified.The autophagic activity was further analyzed through LC3 immunofluorescence and transmission electron microscopy(TEM).An in vivo heterotopic bone formation assay was conducted in mice to assess the role of DAPK2 in ossification.Results:Elevated DAPK2 expression was confirmed in both OPLL patient tissues and derived fibroblasts,in contrast to non-OPLL controls.Silencing of DAPK2 significantly curtailed osteogenic differentiation and autophagy in these fibroblasts,evidenced by decreased levels of LC3,and Beclin1,and reduced autophagosome formation.Additionally,DAPK2 was found to inhibit the mechanistic target of the rapamycin complex 1(mTORC1)complex’s activity.In vivo studies demonstrated that DAPK2 facilitates ossification,and this effect could be counteracted by the mTORC1 inhibitor rapamycin.Conclusion:DAPK2 enhances autophagy and osteogenic processes in OPLL through modulation of the mTORC1 pathway.

Debate on direct-anterior vs posterior approach for hip hemiarthroplasty:The authors’insights

We read and discussed the study entitled“Complication rates after direct anterior vs posterior approach for Hip Hemiarthroplasty in elderly individuals with femoral neck fractures”with great interest.The authors have done justice to the topic of comparison of anterior and posterior surgical approaches for bipolar hemiarthroplasty which has been an everlasting debate in the existing literature.However,there are certain aspects of this study that need clarification from the authors.

Arthroscopic M-shaped suture fixation for tibia avulsion fracture of posterior cruciate ligament:A modified technique and case series

BACKGROUND Tibial avulsion fractures of the posterior cruciate ligament(PCL)are challenging to treat and compromise knee stability and function.Traditional open surgery often requires extensive soft tissue dissection,which may increase the risk of morbidity.In response to these concerns,arthroscopic techniques have been evolving.The aim of this study was to introduce a modified arthroscopic tech-nique utilizing an M-shaped suture fixation method for the treatment of tibial avulsion fractures of the PCL and to evaluate its outcomes through a case series.AIM To evaluate the effects of arthroscopic M-shaped suture fixation on treating tibia avulsion fractures of the PCL.METHODS We developed a modified arthroscopic M-shaped suture fixation technique for tibia avulsion fractures of the PCL.This case series included 18 patients who underwent the procedure between January 2021 and December 2022.The patients were assessed for range of motion(ROM),Lysholm score and International knee documentation committee(IKDC)score.Postoperative complications were also recorded.RESULTS The patients were followed for a mean of 13.83±2.33 months.All patients showed radiographic union.At the final follow-up,all patients had full ROM and a negative posterior drawer test.The mean Lysholm score significantly improved from 45.28±8.92 preoperatively to 91.83±4.18 at the final follow-up(P<0.001),and the mean IKDC score improved from 41.98±6.06 preoperatively to 90.89±5.32 at the final follow-up(P<0.001).CONCLUSION The modified arthroscopic M-shaped suture fixation technique is a reliable and effective treatment for tibia avulsion fractures of the PCL,with excellent fracture healing and functional recovery.

Calcineurin inhibitors-related posterior reversible encephalopathy syndrome in liver transplant recipients: Three case reports and review of literature

BACKGROUND Posterior reversible encephalopathy syndrome(PRES),characterized by acute neurological deterioration and extensive white matter lesions on T2-fluid attenuated inversion recovery magnetic resonance imaging(MRI),is increasingly associated with calcineurin inhibitors(CNI)-related neurotoxicity.Prompt diagnosis is crucial,as early intervention,including the modification or discontinuation of CNI therapy,strict blood pressure management,corticosteroid treatment,and supportive care can significantly improve patient outcomes and prognosis.The growing clinical recognition of CNI-related PRES underscores the importance of identifying and managing this condition in patients presenting with acute neurological symptoms.CASE SUMMARY This report describes three cases of liver transplant recipients who developed PRES.The first case involves a 60-year-old woman who experienced seizures,aphasia,and hemiplegia on postoperative day(POD)9,with MRI revealing ischemic foci followed by extensive white matter lesions.After replacing tacrolimus,her symptoms improved,and no significant MRI abnormalities were observed after three years of follow-up.The second case concerns a 54-year-old woman with autoimmune hepatitis who developed headaches,seizures,and extensive white matter demyelination on MRI on POD24.Following the switch to rapamycin and the initiation of corticosteroids,her symptoms resolved,and she was discharged on POD95.The third case details a 60-year-old woman with hepatocellular carcinoma who developed PRES,evidenced by brain MRI abnormal-ities on POD11.Transitioning to rapamycin and corticosteroid therapy led to her full recovery,and she was discharged on POD22.These cases highlight the critical importance of early diagnosis,CNI modification,and stringent management in improving outcomes for liver transplant recipients with CNI related PRES.CONCLUSION Clinical manifestations,combined with characteristic MRI findings,are crucial in diagnosing PRES among organ transplant recipients.However,when standard treatments are ineffective or MRI results are atypical,alternative diagnoses should be taken into considered.

Direct anterior compared to posterior approach for hip hemiarthroplasty following femoral neck fractures

The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood.Dislocation,a severe complication associated with increased mortality and often requiring additional surgery,may occur less frequently with the direct anterior approach compared to the posterior approach.Careful consideration of patient demographics is essential when planning the surgical approach.Future research in this area should focus on robust randomized controlled trials involving elderly patients recovering from femoral neck fractures.

Atypical presentation of a posterior fossa tumour:A case report

BACKGROUND We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress.This is of interest as the patient had no other symptomatology,especially given the size of the mass,which would typically cause a pressure effect leading to neurological and auditory symptoms.CASE SUMMARY This case report described a 48-year-old male who was married with two children and employed as a car guard.He had a medical history of asthma for the past 10 years controlled with an as-needed beta 2 agonist metered dose inhaler.He initially presented to our facility with severe respiratory distress.He reported a 1-wk history of shortness of breath and wheezing that was not relieved by his bronchodilator.He had no constitutional symptoms or impairment of hearing.On clinical examination,the patient’s chest was“silent.”Our initial assessment was status asthmaticus with type 2 respiratory failure,based on the history of asthma,a“silent chest,”and the arterial blood gas results.CONCLUSION A posterior fossa meningioma of such a large size and with extensive infiltration rarely presents with an isolated unilateral vocal cord palsy.The patient’s chief presenting feature was severe respiratory distress,which combined with his background medical history of asthma,was misleading.Clinicians should thus consider meningioma as a differential diagnosis for a unilateral vocal cord palsy even without audiology involvement.

Regional dynamic cerebral autoregulation across anterior and posterior circulatory territories:A detailed exploration and its clinical implications

Cerebral autoregulation(CA)is the mechanism that maintains stable cerebral blood flow(CBF)despite fluctuations in systemic blood pressure,crucial for brain homeostasis.Recent evidence highlights distinct regional variations in CA between the anterior(carotid)and posterior(vertebrobasilar)circulations.Noninvasive neuromonitoring techniques,such as transcranial Doppler,transfer function analysis,and near-infrared spectroscopy,facilitate the dynamic assessment of CBF and autoregulation.Studies indicate a robust autoregulatory capacity in the anterior circulation,characterized by rapid adjustments in vascular resistance.On the contrary,the posterior circulation,mainly supplied by the vertebral arteries,may have a lower autoregulatory capacity.in acute brain injuries such as intracerebral and subarachnoid hemorrhage,and traumatic brain injuries,dynamic CA can be significantly altered in the posterior circulation.Proposed physiological mechanisms of impaired CA in the posterior circulation include:(1)Decreased sympathetic innervation of the vasculature impairing compensatory vasoreactivity;(2)Endothelial dysfunction;(3)Increased cerebral metabolic rate of oxygen consumption within the visual cortex causing CBFmetabolism(i.e.,neurovascular)uncoupling;and(4)Impaired blood-brain barrier integrity leading to impaired astrocytic mediated release of vasoactive substances(e.g.nitric oxide,potassium,and calcium ions).Furthermore,more research is needed on the effects of collateral circulation,as well as the circle of Willis variants,such as the fetal-type posterior cerebral artery,on dynamic CA.Improving our understanding of these mechanisms is crucial to improving the diagnosis,prognosis,and management of various cerebrovascular disorders.

Risk factors and clinical significance of posterior slip of the proximal vertebral body after lower lumbar fusion

BACKGROUND Adjacent segment disease(ASD)after fusion surgery is frequently manifests as a cranial segment instability,disc herniation,spinal canal stenosis,spondylolisthesis or retrolisthesis.The risk factors and mechanisms of ASD have been widely discussed but never clearly defined.AIM To investigate the risk factors and clinical significance of retrograde movement of the proximal vertebral body after lower lumbar fusion.METHODS This was a retrospective analysis of the clinical data of patients who underwent transforaminal lumbar interbody fusion surgery between September 2015 and July 2021 and who were followed up for more than 2 years.Ninety-one patients with degenerative lumbar diseases were included(22 males and 69 females),with an average age of 52.3 years(40-73 years).According to whether there was retrograde movement of the adjacent vertebral body on postoperative X-rays,the patients were divided into retrograde and nonretrograde groups.The sagittal parameters of the spine and pelvis were evaluated before surgery,after surgery,and at the final follow-up.At the same time,the Oswestry Disability Index(ODI)and Visual Analogue Scale(VAS)were used to evaluate the patients’quality of life.RESULTS Nineteen patients(20.9%)who experienced retrograde movement of proximal adjacent segments were included in this study.The pelvic incidence(PI)of the patients in the retrograde group were significantly higher than those of the patients in the nonretrograde group before surgery,after surgery and at the final follow-up(P<0.05).There was no significant difference in lumbar lordosis(LL)between the two groups before the operation,but LL in the retrograde group was significantly greater than that in the nonretrograde group postoperatively and at the final follow-up.No significant differences were detected in terms of the|PI–LL|,and there was no significant difference in the preoperative lordosis distribution index(LDI)between the two groups.The LDIs of the retrograde group were 68.1%±11.5%and 67.2%±11.9%,respectively,which were significantly lower than those of the nonretrograde group(75.7%±10.4%and 74.3%±9.4%,respectively)(P<0.05).Moreover,the patients in the retrograde group had a greater incidence of a LDI<50%than those in the nonretrograde group(P<0.05).There were no significant differences in the ODI or VAS scores between the two groups before the operation,but the ODI and VAS scores in the retrograde group were significantly worse than those in the nonretrograde group after the operation and at the last follow-up,(P<0.05).CONCLUSION The incidence of posterior slippage after lower lumbar fusion was approximately 20.9%.The risk factors are related to a higher PI and distribution of lumbar lordosis.When a patient has a high PI and insufficient reconstruction of the lower lumbar spine,adjacent segment compensation via posterior vertebral body slippage is one of the factors that significantly affects surgical outcomes.

Presentation and management outcome of foot drop with tibialis posterior tendon transfer

BACKGROUND Foot drop causes considerable disability.The ankle-dorsiflexion is either weak or lost completely.Additionally,the ankle eversion and toe extensions are also impaired.This results in a high steppage gait while walking.Overall,the gait is awkward;there is greater energy consumption;increased proneness to sustain injury of the forefoot;and more frequent falling during walking.AIM To document the clinical and epidemiological profile of foot drop patients in our population and evaluate the outcome of tibialis posterior(TP)tendon transfer for restoring the lost dorsiflexion in foot drop.METHODS The study was carried out at the National Institute of Rehabilitation Medicine in Islamabad over a period of 7 years.It included patients of all sexes and ages who presented with foot drop and had no contraindications for the procedure of TP tendon transfer.Exclusion criteria were patients who had contraindications for the operation.For instance,paralyzed posterior leg compartment muscles,Achilles tendon contracture,stiff ankle or toes,unstable ankle joint,weak gastrocnemius and scarred skin spanning over the route of planned tendon transfer.Also,patients who had the foot drop as a result of disc prolapses or brain diseases were excluded.Convenience sampling technique was used.The circum-tibial route of TP tendon transfer was employed.RESULTS Out of 37 patients,26(70.27%)were males whereas 11(29.72%)were females.The mean age was 22.59±8.19 years.Among the underlying causes of foot drop,road traffic accidents constituted the most common cause,found among 20(54.05%)patients.The share of complications included wound infections in 3(8.10%)patients and hypertrophic scars in 2(5.40%)patients.At 1-year postoperative follow-up visits,the outcome was excellent in 8(21.62%),good in 20(54.05%)and moderate in 9(24.31%).CONCLUSION The majority of cases of foot drop resulted from road traffic accidents that directly involved the common peroneal nerve.TP tendon transfer through the circumtibial route was found to be an easily executed effective operation which restored good dorsiflexion of the ankle among the majority of patients.

Tacrolimus-induced posterior reversible encephalopathy syndrome following liver transplantation

In this editorial,we talk about a compelling case focusing on posterior reversible encephalopathy syndrome(PRES)as a complication in patients undergoing liver transplantation and treated with Tacrolimus.Tacrolimus(FK 506),derived from Streptomyces tsukubaensis,is a potent immunosuppressive macrolide.It inhibits Tcell transcription by binding to FK-binding protein,and is able to amplify glucocorticoid and progesterone effects.Tacrolimus effectively prevents allograft rejection in transplant patients but has adverse effects such as Tacrolimus-related PRES.PRES presents with various neurological symptoms alongside elevated blood pressure,and is primarily characterized by vasogenic edema on neuroimaging.While computed tomography detects initial lesions,magnetic resonance imaging,especially the Fluid-Attenuated Inversion Recovery sequence,is superior for diagnosing cortical and subcortical edema.Our discussion centers on the incidence of PRES in solid organ transplant recipients,which ranges between 0.5 to 5+ACU-,with varying presentations,from seizures to visual disturbances.The case of a 66-year-old male status post liver transplantation highlights the diagnostic and management challenges associated with Tacrolimus-related PRES.Radiographically evident in the parietal and occipital lobes,PRES underlines the need for heightened vigilance among healthcare providers.This editorial emphasizes the importance of early recognition,accurate diagnosis,and effective management of PRES to optimize outcomes in liver transplant patients.The case further explores the balance between the efficacy of immunosuppression with Tacrolimus and its potential neurological risks,underlining the necessity for careful monitoring and intervention strategies in this patient population.

Catheter-Assisted Interlaminar Approach for Cervical Epidural Steroid Injection in Patient with Cervical Stenosis Caused by Ossification of Posterior Longitudinal Ligament: A Case Report

We present the case of a 64-year-old man with cervical ossification of the posterior longitudinal ligament (OPLL) experiencing chronic neck pain and radiculopathy for 6 months. A catheter-assisted interlaminar Cervical Epidural Steroid Injection (CESI) was performed under fluoroscopic guidance, targeting the affected C2-C6 levels. Significant improvement was observed after this procedure, with decreased pain scores (visual analogue scale (VAS) 8 to 2) and improved mobility. This technique not only enhances the effectiveness of CESI but also reduces the likelihood of complications such as stroke or epidural hematoma and thus provides an alternative treatment option for patients with multiple stenotic levels who are unsuitable for surgery or are unresponsive to conservative therapy such as medication or physical therapy.

Clinical Effect Analysis of Posterior Chamber Intraocular Lens Implantation for Correcting High Myopia and Astigmatism

Objective:To explore the corrective effect of posterior chamber intraocular lens implantation with phakic eyes in the treatment of high myopia and astigmatism.Methods:From May 2023,the hospital began to collect the case data of diagnosis and treatment of high myopia and astigmatism.By May 2024,310 cases were included,all of which were treated with posterior chamber intraocular lens implantation.The visual acuity,astigmatism and axial position of the intraocular lens were observed before and after treatment.Results:At different time points after the operation,the patient’s vision was significantly improved compared with that before the operation(P<0.05),and the vision level was equal to or greater than the best-corrected vision before the operation.At different time points after the operation,the average rotation of the intraocular lens was less than 5 degrees.Astigmatism was significantly lower than that before the operation(P<0.05).After the operation,the intraocular pressure increased in 11 cases,accounting for 3.55%,with no adverse complications such as lens turbidity,glare and obvious halo occurring.Conclusion:The posterior chamber intraocular lens implantation with phakic eyes has an ideal correction effect in the treatment of high myopia and astigmatism,which can effectively improve the vision level of patients and reduce the degree of astigmatism,and has high effectiveness and safety.

颈椎前路椎体骨化物可控前移融合对后纵韧带骨化物和内植物影响的有限元分析

背景:颈椎前路椎体骨化物可控前移融合对颈椎力学的影响尚未明确,既往研究主要集中在颈椎前路椎体骨化物可控前移融合的手术技巧、中长期疗效和术后并发症等。目的:运用有限元方法分析颈椎前路椎体骨化物可控前移融合对颈椎后纵韧带骨化物和内植物生物力学的影响。方法:选择一名健康男性志愿者进行全颈椎薄层CT扫描,应用有限元分析软件构建正常全颈椎模型,与既往文献进行对比验证其有效性;随后在模型上构建累及C4、C5和C6节段的连续型颈椎后纵韧带骨化物的术前模型;以术前模型为基础,创建颈椎前路椎体骨化物可控前移融合手术三维有限元模型,约束2个模型C7椎体下表面,于C1椎体上表面施加50 N的轴向力和1.0 N·m的力矩,在屈伸、侧弯、旋转6个工况下,分析颈椎前路椎体骨化物可控前移融合对骨化物和内植物应力的影响。结果与结论:①从术前模型得出骨化物应力主要集中在C4/5节段,在前屈、后伸、左侧弯、右侧弯、左旋转、右旋转6个工况下骨化物最大应力分别为10.1,148.6,68.9,74.8,83.8和85.1 MPa;②颈椎前路椎体骨化物可控前移融合术后,骨化物应力集中分布区域未见明显改变,但该手术会改变骨化物应力大小,除在前屈位颈椎前路椎体骨化物可控前移融合模型骨化物应力较术前模型增大(+44.7%)外,在其他5个工况下,骨化物应力较术前模型明显降低,其中后伸位下降最明显(-74.1%),在左侧弯、右侧弯、左旋转、右旋转下骨化物应力分别下降62.2%,63.3%,66.4%,67.9%;③钛板、螺钉应力主要集中在头尾两端,后伸应力最大(149.5 MPa),前屈应力最小(43.3 MPa);4个椎间融合器应力主要集中在C3/4、C6/7融合器,应力主要分布在融合器的上下表面周围,后伸应力最大(30.8 MPa),前屈应力最小(11.5 MPa);内植物(钛板、螺钉和椎间融合器)应力主要集中于头尾两端,应力较大易导致头尾两端钛板、螺钉断裂和内植物下沉;④提示颈椎前路椎体骨化物可控前移融合能明显降低骨化物应力,可能有助于防止过度增生从而压迫神经,在术后需密切关注头尾两端螺钉松动、断裂或钛板移位、断裂等情况。

后外侧胫骨平台骨折应用万向螺钉的有限元分析

背景:通过腓骨头上入路治疗后外侧胫骨平台骨折时,腓骨头与外侧平台间隙差无法满足所有患者行钢板后置。目的:有限元法分析腓骨头上入路治疗后外侧胫骨平台骨折过程中钢板横臂万向螺钉角度以及数量不同导致固定强度的差异。方法:选用一名30岁健康成年男性志愿者膝关节至踝关节的CT图像,建立有限元模型。根据外侧锁定加压钢板是否后置分为后置组和非后置组,后置组根据2枚万向螺钉的偏移角度分为A-D组(0°,5°,10°,15°);非后置组根据2枚万向螺钉的偏移角度分为E,F组(0°,15°)。采用有限元法评估250,500,750 N载荷下的von Mises应力分布、最大von Mises应力和压缩位移,探究各组之间的力学差异。结果与结论:①有限元分析结果显示:750 N载荷水平下,内固定装置的最大压缩位移趋势为D<B=C=F<A<E,最大von Mises应力趋势为B<C<A<D<F<E,骨的最大压缩位移趋势为C=D<B<A<F<E,最大von Mises应力趋势为B<C<A<F<D<E;6组模型在250-750 N的位移和应力趋势相似;②提示通过腓骨头上入路固定后外侧胫骨平台骨折,应尽量满足钢板后置2枚螺钉固定;当术中后置钢板仅满足1枚螺钉固定时,可使用万向螺钉在0°-15°范围内后偏,增加2枚螺钉的固定概率。