Bipolar hip arthroplasty using conjoined tendon preserving posterior lateral approach in treatment of displaced femoral neck fractures

BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.

Twin fetuses associated with double amniotic sacs diagnosed using transvaginal ultrasonography:A case report

BACKGROUND Conjoined twins are a rare twin malformation commonly presenting as single amniotic sac twinning,with double amniotic sac twinning being extremely rare and poorly reported.Most conjoined twins are females.CASE SUMMARY A woman of childbearing age conceived naturally,and at 8 wk of gestation,transvaginal ultrasonography showed an embryo and cardiac tube pulsation in both amniotic sacs.On dynamic observation,the two embryos were connected in the lower abdomen,with restricted movement.A repeat transvaginal ultrasound at 11 wk showed that the intestinal tubes of both fetuses were connected in the lower abdomen.The pregnancy was terminated and labor was induced.CONCLUSION Transvaginal ultrasound may detect conjoined twin malformations in an early stage.Our case provides diagnostic insights for ultrasonographers and can help develop early therapeutic interventions.

Role of Fresh Cadaver Practice and Jesus Prayers on Daily Base in Innovations of a Difficult Neurosurgical Operation (Craniopagus Separation)

Purpose: Challenging cases in neurosurgery require experience, which is gained by operating on a number of similarly difficult cases. However, even in large population centers, there are extremely rare cases, such as craniopagus twins. In these instances, other case-specific solutions are required which were improved in the course of fresh cadaver practice on daily base. Methods: During a 20-month preparation period by fresh cadavers the surgical strategy was developed step by step, comprising five neurosurgical ideas, facilitated by deep Jesus prayers as a spiritual source. Possible causes of postoperative complications that occured on 33d postoperative day were also analyzed. Results: During surgery, these nuances proved to be useful, which is also reflected by the postoperative clinical results. One of the twins advanced to a GOS score of 5three months after the surgery. The other twin, despite nonsurgical septic complications, continued to progress well, but on postoperative day 33 for seemingly unknown reasons, she suffered a severe cerebral hemorrhage, which significantly delayed her rehabilitation. A thorough revision of the whole process much later revealed a pitfall that could have a role in this complication. Conclusions: The challenging neurosurgical separation of the craniopagus twins was carried out successfully with the help of five novel neurosurgical refinements, which were found during 300 fresh cadaver practices. Mistakes can serve as a lesson. We hope that the procedures developed and the knowledge gained can be applied in the future.

THEORY AND IMPLEMENTATION OF ICAI COGNITIVE MODEL BASED ON MEANING

Cognitive models must be able to adapt the students learning behaviors dynamically.In our point of view,the processes of learning and understanding are,in nature,the procedure that gains the meaning of the object to be learned.So,ICAI cognitive models should reflect the meaning structure of the domain knowledge in students mind.According to this view,we developed the meaning theory of Ludwig Wittgenstein,and proposed the concept of meaning conjoinism.On the basis of the meaning conjoinism we proposed a meaning oriented ICAI cognitive model and its corresponding teaching tactics.Furthermore,we developed an ICAI system named Thinking and the efficiency of our proposal has been demonstrated.

Observation and analysis of morphology abnormalities in development of Oryzias melastigma embryos

Fish embryos are widely used as models in toxicology,drug development,and human disease research because of their high sensitivity,observability,and operability,providing the basis for an in-depth understanding of the embryogenesis.Increasing studies have indicated that birth defects are hereditary.In this study,we used Oryzias melastigma as a model to conduct a study of 185-day embryogenesis and observed self-induced non-pathological abnormal embryogenesis.O.melastigma experienced pre-puberty stage,adolescence stage,and senescence stage,and individuals produced up to 102 eggs per day.However,the fecundity was markedly reduced during the senescent stage.During the active egg and blastodisc stages,pseudo-fertilization and pseudo-blastocysts were observed.During cleavage at the 4-to 32-cell stages,we observed blastomeres separation or dislocation.Excessively separated blastomeres formed double blastoderms,eventually resulting in conjoined twins.During the blastula stage,we observed abnormally increased cell volume,narrowed and elongated blastocysts,and abnormally coated blastoderms.At the organogenesis stage,we observed abnormal numbers of Kupff er’s vesicles and conjoined twins.Abnormality in the location and number of oil droplets were observed in various development stages.Abnormal development was more commonly observed in fertilized eggs produced by broodstock in pre-puberty or senescence stages,which is probably related to the age of fish and the egg quality.This study can provide the materials for comparative analysis in toxicological and molecular studies of O.melastigma,and may provide evidence for other economic fish that produce sticky eggs.

Early ultrasound diagnosis of conjoined twins at eight weeks of pregnancy: A case report

BACKGROUND Conjoined twins are a rare occurrence,and the majority of these malformations are detected during second trimester screening.CASE SUMMARY Herein we report a case of conjoined twins,which was diagnosed by ultrasound at 8 wk gestation and was normal at 7 wk gestation.The two fetuses shared one heart and were diagnosed as thoracopagus twins.This is the first report of conjoined twins diagnosed at 8 wk gestation.The pregnancy was terminated electively at 9 wk gestation.Because some congenital malformations can be diagnosed earlier,a prenatal ultrasound examination at an early gestational stage cannot be dismissed.CONCLUSION This case demonstrates that a 7-8 wk gestation might be the earliest period when conjoined twins can be diagnosed by ultrasound.

Application Value of Musculoskeletal Ultrasound in DAA-THA with Conjoined Tendon Repair

Objective:To observe the ultrasonographic characteristics of conjoined tendon repair in direct anterior approach for total hip arthroplasty(DAA-THA),and to evaluate the efficacy of musculoskeletal ultrasound in determining the healing after joint tendon repair.Methods:A total of 60 patients who required primary total hip arthroplasty in Yulin Orthopedic Hospital of Chinese and Western Medicine from July 2020 to July 2021 were selected;the patients were divided into two groups,an observation group,group A(n=30),and a control group,group B(n=30),according to different intraoperative methods.There was no significant difference in gender,age,and diagnosis between the two groups.Direct anterior approach was used for both the groups.For group A,the joint capsule and conjoined tendon(superior gemellus,obturator internus,and inferior gemellus)were repaired in situ,whereas for group B,only the joint capsule was repaired in situ,while the conjoined tendon was not repaired.The healing of the tendon was observed.Results:(1)in terms of diagnosis,after conjoined tendon repair,26 cases in group A showed good tendon continuity,good tension,and a small amount of effusion echo around,three cases showed partial interruption of tendon echo,low echo,or no echo inside with insufficient structural clarity,and a case showed complete interruption;in group B,all 30 cases had continuous interruption,poor tension,tendon retraction,and thickening;the healing rate of group A’s conjoined tendon repair was 96.67%;(2)in terms of prognostic assessment,one month after the surgery,the Harris score of group A was significantly higher than that of group B(P<0.05);however,there was no significant difference in the terms of the Harris score between the two groups 3-6 months after surgery(P>0.05);the effective tension of conjoined tendon and the effective muscle strength of group A were significantly higher than those of group B(P<0.05).Conclusion:Musculoskeletal ultrasound has high diagnostic value in the healing of conjoined tendon and provides dynamic clinical observation after conjoined tendon repair in DAA-THA;it is proven that DAA-THA with conjoined tendon repair on the premise of reconstructing the joint capsule can well restore its tension,enhance its muscle strength,significantly improve early joint stability and joint function,as well as facilitate the rapid recovery of patients.

Comparative evaluation of urolithiasis management options in patients with horseshoe kidney:A systematic review and meta-analysis

Background:Horseshoe kidney is a rare congenital anomaly commonly complicated by urolithiasis.Extracorporeal shockwave lithotripsy(ESWL),ureteroscopy(URS),and percutaneous nephrolithotomy(PCNL)are treatment options for horseshoe kidney stones.The aim of this systematic review is to compare the benefits and risks of these management options.Methods:MEDLINE,EMBASE,and Cochrane Library databases were searched from inception to February 2022.A total of 516 nonduplicate studies were screened against the inclusion and exclusion criteria.Studies comparing at least 2 interventions with>10 patients per intervention were included.Results:Nine retrospective observational studies published from 2007 to 2021 with a total of 565 patients were included.Reported mean±SD or mean(range)stone sizes ranged between 17.90±2.43 mm and 27.9±8.6 mm for PCNL,8.4(2-25)mm and 22.3±9.1 mm for URS,and 11.9±2.0 mm and 16.8±4.4 mm for ESWL.There was no difference in single-session and overall stone-free rate(SFR)between PCNL and URS,with a risk ratio of 1.04(95%confidence interval,0.95-1.13;I2=20.63%).Ureteroscopy had better stone clearance than ESWL,with an overall SFR risk ratio of1.38(95%confidence interval,1.04-1.82;I2=0%).There was no statistically significant difference in overall SFR between PCNL and ESWL.Most patients who underwent URS and ESWL experienced Clavien-Dindo(CD)gradeⅠ-Ⅱcomplications.Percutaneous nephrolithotomy was associated with the highest complication rates,including 5 CD gradeⅢand 3 CD gradeⅣcomplications and a mean postoperative hemoglobin drop of 0.47 to 1.83 g/dL.There were no CD grade V complications across all studies.Conclusions:There was no difference in SFR between PCNL and URS.Ureteroscopy was associated with a smaller stone burden and fewer and less severe complications.Ureteroscopy was found to be more effective than ESWL with a higher SFR and comparable safety profile.Further large-scale randomized controlled trials are needed to confirm these findings.

Preoperative preparation and surgical separation of conjoined pygopagus twins

Conjoined twins are very rare with an estimated ,incidence of about 1 in 200 000 births with a male-female ratio of 1：3 The separation ot conjolned twins presents a challenge to surgeons and also a test for comprehensive efficiency of a hospital. Recently, a rare pair of pygopagus twins were admitted to our hospital and a successful surgical separation was carded out.