The Effect of Torsion Deformity and Medial Knee Osteoarthritis on Lower Limb Extensor Moments during Gait

The aim of this study was to quantify the effect of torsion deformity on the lower limb kinetics during the loading response phase of gait. A total of 24 subjects: 6 end-staged medial knee OA with torsion deformity (TKO), 8 without torsion deformity (KOA), and 10 controls (CON) were imaged using computed tomography (CT). Internal moment of support and sagittal hip, knee and ankle joint moments were assessed using gait analysis. TKO showed greater external rotations of the proximal tibia and the distal femur compared to subjects with medial knee OA without torsion deformity and controls. TKO showed greater moment of support and a greater knee extensor moment when compared to controls when supporting the weight of the body during gait. The TKO intorsion deformity occurred as a result of a proximal malrotation of the tibia. In the presence of torsion deformity, the kinetic synergy of the lower limb showed increased total moment of support for subjects with medial knee OA. The greater extensor output from TKO may be the result of an increased muscular response to overcome an interrupted inter-segmental exchange of accelerations during the loading response phase of gait.

Impact of Age on Surgical Outcomes after Robot Assisted Laparoscopic Hysterectomies

Objective: To estimate the impact of patient’s age on surgical outcomes in patients undergoing robotic hysterectomy. Methods: A retrospective review of prospectively collected cohort data for a consecutive series of patients undergoing gynecologic robotic surgery. Patient’s age and perioperative variables were collected from the database, charts, and other hospital records of all patients undergoing robotic hysterectomy. Results: 399 patients underwent robotic surgery for gynecologic disease. 370 patients who were under age 70 were compared with 29 patients who were over age 70. When comparing all patients under age 70 with patients over age 70, the mean age was 48.4 and 77 (P?2 (P < 0.05), mean procedure time was 185 and 211 minutes (min) (P?=?0.09), mean console time?was?123 and 148 min (P?=?0.056), mean OR (Operating room) time?was?237 and 273, mean EBL (Estimated blood loss) was 71 and 65 ml (P?=?0.74), Hb (Hemoglobin) drop?was?1.4 and 1.2 (P?=?0.45), uterine weight was 212 and 95 gm (P?= 0.98), and length of stay was 1.4 and 1.6 days (P?=?0.33) (Table 1). The patients over age 70, when procedures were combined, had a statistically significant lower mean BMI, uterine weight and longer Operating room (OR) time. However, when stratified by the type of procedure performed, there was no difference in surgery times among those under 70 and over 70 years of age. The elderly patients were more likely to have cancer, which was in almost half the elderly patients, and thus necessitate staging. Thus adding the performance of lymph node dissection likely resulted in the increased length of the surgery time that was noted in the combined group (Tables 1,2). There were no operative deaths. Conclusions: Advanced age does not appear to be associated with an increased risk of morbidity, or adverse perioperative outcomes in patients undergoing robotic hysterectomy.

Prone Transpsoas Approach for Adjacent Segment Disease and Flatback Deformity: Technical Note and Case Report

The prone transpsoas approach is a relatively new technique to correct segmental kyphosis and global sagittal imbalance in a minimally invasive fashion. Here, we provide a detailed case report using the prone transpsoas approach to address adjacent segment disease and flatback deformity. This technique allows considerable restoration of segmental lordosis with lateral interbody placement and posterior decompression and fusion using a single position approach. Our experience with the surgical technique and the advantages and challenges unique to this approach are discussed.

Trans-cranial Doppler predicts early neurologic deterioration in anterior circulation ischemic stroke after successful endovascular treatment

Background:Early neurologic deterioration(END)may occur in patients with anterior circulation ischemic stroke(ACIS)after receiving endovascular treatment(EVT).Hemodynamic insufficiency,re-occlusion,and post-re-canalization hyper-perfusion are likely to play a critical role in END.We hypothesized that hemodynamic changes can predict END in patients with ACIS postsuccessful EVT using trans-cranial Doppler(TCD).Methods:We utilized a prospectively maintained database of ACIS patients treated with EVT between September 2016 and June 2018 in the Xuanwu Hospital,Capital Medical University.TCD parameters including peak systolic velocity(PSV),bilateral mean flow velocity(MFV),and pulse index(PI)were determined via the middle cerebral arteries within 72 h post-EVT.A logistic regression model was applied to detect independent predictors for END.Results:Totally,112 EVT patients were included in this study and 80/112 patients experienced successful re-canalization with<50%residual stenosis,while 17/80(21.3%)patients suffered END,for which vasogenic cerebral edema(11/17)was considered as a leading role and followed by symptomatic intra-cranial hemorrhage(4/17)and ischemia progression(2/17).For the 80 patients,the PSV(median:127 cm/s vs.116 cm/s,P=0.039),the ratio of ipsilateral-MFV/contra-lateral-MFV(iMFV/cMFV)(median:1.29 vs.1.02,P=0.036)and iMFV/mean blood pressure(MBP)(median:0.97 vs.0.79,P=0.008)in END patients were higher than those of non-END.Using the receiver-operating characteristic curve to obtain cut-off values for PSV,PI,iMFV/cMFV,and iMFV/MBP for END,we found that PI≥0.85(odds ratio:11.03,95%confidence interval:1.92–63.46,P=0.007)and iMFV/MBP≥0.84(odds ratio:9.20,95%confidence interval:2.07–40.84,P=0.004)were independent predictors of END in a multivariate logistic regression model,with a sensitivity of 82.4%and 76.5%and a specificity of 42.9%and 66.7%,respectively,and had the positive predictive values of 29.0%and 38.2%,and negative predictive values of 90.0%and 91.3%,with an area under the receiveroperating characteristic curve of 0.57 and 0.71,respectively.Conclusion:TCD examination of EVT patients may be used as a real-time tool to detect END predictors,such as the higher PI and iMFV/MBP,allowing for better post-thrombectomy management in ACIS patients.