Search Results (34)

Background: Surgical management of adult patients with post-dysplastic coxarthrosis using total hip arthroplasty is technically demanding and carries an increased risk of complications. In cases of high iliac dislocation classified as Crowe type IV, restoring the acetabular component to the anatomical hip centre often requires femoral shortening osteotomy to enable safe reduction in the prosthetic joint. Nevertheless, long-term evidence on functional outcomes and prosthesis survival with this approach is limited. Methods: A retrospective cohort study included 19 patients with 22 cases of Crowe type IV post-dysplastic hip osteoarthritis treated with uncemented total hip arthroplasty (Pinnacle/S-ROM, DePuy, Warsaw, IN, USA) combined with transverse subtrochanteric femoral shortening osteotomy. Patients underwent serial clinical follow-up, including assessment of range of motion, measurement of limb-length discrepancy, and functional evaluation using the Harris Hip Score and the WOMAC questionnaire. Radiological assessment included evaluation of osteotomy union, implant positioning, and osteolysis on standardized radiographs. Vertical distances of the centre of rotation (CR), the tip of the greater trochanter (GT), and the tip of the lesser trochanter (LT) from both reference lines were measured bilaterally, and inter-side differences were calculated. The reference lines consisted of the line connecting the inferior margins of the ischial bones and the teardrop (TD) line. Results: All osteotomies united at a mean of 5.57 months, with a mean follow-up of 129 months. Mean limb-length discrepancy decreased from 5.27 cm to 1.5 cm, and mean hip flexion improved from 82.9° to 106°. Functional outcomes improved significantly, with mean WOMAC increasing from 55.4 to 80.1 (p < 0.001) and mean Harris Hip Score from 49.8 to 84.66 at up to 3 years of follow-up (p < 0.001). Osteotomy length correlated strongly with lesser trochanter–teardrop distance (p = 0.00000048). Complications included distal femoral fissure (27.3%) and revision (18%), with no infection or permanent neurological deficit. Conclusions: Total hip arthroplasty combined with subtrochanteric femoral shortening osteotomy for Crowe type IV post-dysplastic hip osteoarthritis appears to be a feasible and effective procedure in an experienced centre, providing reliable osteotomy healing and significant early functional improvement that is sustained over time. Limb-length discrepancy was reduced and satisfactory biomechanical restoration was achieved, with an acceptable complication profile and implant survival of 81.3% at long-term follow-up. The LT–TD parameter was identified as a potential predictor of osteotomy length, enabling the proposal of a preoperative planning equation. However, given the limited sample size and lack of validation, these findings should be interpreted cautiously. Further studies are needed to confirm their broader applicability. Full article

Objective: This study aimed to compare the clinical outcomes of navigation-assisted and conventional (freehand) ventriculoperitoneal (VP) shunt placement in pediatric hydrocephalus patients. Methods: A retrospective review was conducted of 164 patients under the age of 18 who underwent VP shunt placement for hydrocephalus between 2015 and 2023 and had a minimum postoperative follow-up of 12 months. The conventional technique was used in 116 patients. The navigation-assisted technique (intraoperative ultrasonography or frameless neuronavigation) was used in 48 patients. Demographic data, hydrocephalus etiology, catheter tip position (Yim classification), revision rates, infection, complications, and length of hospital stay were recorded. Catheter tip position was assessed on postoperative imaging by two independent investigators. Results: No significant differences were found between the groups in terms of age, sex, and hydrocephalus etiology. The optimal catheter placement rate was significantly higher in the navigation-assisted group compared to the conventional technique (81.25% vs. 60.34%, p = 0.017). The revision rate was significantly lower in the navigation-assisted group (16.67% vs. 38.79%, p = 0.010). The mean hospital stay was shorter in the navigation-assisted group (7.85 ± 3.97 days vs. 10.20 ± 3.70 days, p < 0.001). The groups were similar in terms of infection (2.08% vs. 9.48%, p = 0.183) and overall complication rates (14.58% vs. 16.38%, p = 0.959). Conclusions: Navigation-assisted VP shunt placement in pediatric hydrocephalus patients is associated with a high rate of optimal catheter position, a low revision rate, and a short hospital stay. These findings support the use of navigation technology in pediatric hydrocephalus surgery, but also reveal that infection and complications are unassociated with the surgical technique. Full article

Background: The use of tapered fluted revision stems has been shown to be reliable and safe. Primary stability is mandatory for a long-lasting fixation between bone and a prosthesis. Nevertheless, aseptic loosening due to insufficient primary stability occurs and may be related to technically improper preparation of the femoral canal. Instructions of manufacturers are heterogeneous regarding preparation of implant beds. Questions/Purposes: Does speed or the design of the reamer influence the accuracy of the implant bed and, consecutively, primary stability? Materials and Methods: A test foam with an elastic moduli and pressure resistance similar to that of cancellous bone was used. The medullary canal was prepared with the use of reamers of two different straight and tapered femoral revision devices. Three different rotational speeds were used for preparation. After preparation, primary stability was measured and fixating characteristics were derived. Results: Sufficient primary stability was achievable by all three preparation methods but fixating characteristics were different. Significantly higher micro-motions were detected near the tip of the prosthesis compared to those at all more proximal measuring points. Reaming with high velocity resulted in significantly higher micro-motions compared to that with mid- or low-speed burring. Conclusions: Different preparation methods may be one explanation for the range of reported survivorship data of the two devices with aseptic loosening as the end point. The precision of the implant bed and fixating characteristics were best after reaming with lower velocity. Superior but not significantly better fixation characteristics were achieved with the monobloc stem compared to those with the modular device. Full article

Objectives: The indications for femoral endoprosthesis replacement (EPR) use in limb reconstruction have broadened over the last decade. Despite its success, loosening remains the most common reason for failure. No previous system has classified loosening based on the anatomical site in relation to the prosthesis. The aim of this study is to propose a simple reproducible classification system for EPR loosening. Methods: Adult patients that underwent a revision EPR for loosening from 1 January 2023–1 May 2025 were included. Radiographs and computed tomography (CT) images were retrospectively reviewed. The grading was developed on radiographs to classify loosening around EPRs as normal (grade 1), loosening at the shoulder (grade 2), loosening around the shaft of the peg (grade 3), loosening below the tip of the prosthesis (grade 4), associated penetration of prosthesis through the cortex (grade 5), and associated fracture (grade 6). Results: A total of 28 patients were included. The majority of patients were male (n = 17; 61%) with a mean age of 50.6 years (SD 16.1). The average time from the index surgery to diagnosis of loosening was 10.1 years (SD 7.6). The most common pattern of loosening was grade 3 (N = 16; 57.1%). Conclusions: Our classification system proposes an easily adopted way to describe all patterns of loosening around EPRs, potentially guiding revision surgical strategies. Standardizing the approach in evaluating loosening will aid in producing national guidelines for managing this complex complication and may help improve future EPR design. Full article

This study reports two new species of Ampharete and one new record of a species of Amphicteis (Ampharetidae) from the Korean subtidal zone, based on an integrative approach. Ampharete koreana sp. nov. is characterized by paleal chaetae several times thicker than notochaetae, with short filamentous tips. It more closely resembles A. finmarchica but differs in the shape of its paleae, interbranchial gap, thoracic uncini, and pygidial cirri and shows a 2% genetic divergence in histone H3 and in 18% of mtCOI genes. Ampharete namhaensis sp. nov. shares with A. petersenae the absence of paleae and the presence of 16 abdominal uncinigers, a rare combination of traits among known Ampharete species. However, A. petersenae differs in having a marked interbranchial gap, prominent eyes on the prostomium, double the number of abdominal uncini and buccal tentacles, and in its distribution (southern Korea for A. namhaensis sp. nov. vs. North Atlantic and Arctic-adjacent waters for A. petersenae). The Korean Amphicteis specimens examined in this study closely resemble A. glabra in key morphological features, including fine paleae tips, 14 thoracic and 15 abdominal uncinigers, and approximately eight paleae. However, given the need for a comprehensive revision of Amphicteis and the potential for cryptic diversity within the genus, these specimens are provisionally designated as Amphicteis sp. cf. A. glabra. Full article

Background: Despite several challenges in clinical management, there has been significant progress in understanding the aetiology, natural history and outcomes of Budd–Chiari syndrome (BCS) treatments. This study aims to evaluate the outcomes of transjugular intrahepatic portosystemic shunt (TIPS) using covered stent in management of BCS. Methods: We conducted a retrospective analysis of 70 BCS patients who underwent TIPS using covered stents between January 2010 and December 2022 at a single tertiary liver transplant centre. Patients’ clinical features, laboratory parameters, and imagine findings were collected before and after TIPS. The primary endpoint was overall survival. Results: TIPS was performed on 70 patients with BCS out of a total of 88 patients. The remaining patients (18) underwent liver transplantation. The mean age was 37.7 ± 11.2 years at time of diagnosis and the majority were female (64.35). The most common symptoms and signs at presentation were abdominal pain, jaundice, ascites, and variceal bleeding. Over a median followup of 76 months, the survival rates at 1, 3, and 5 years were 98.8%, 97.9%, and 97.7%, respectively. Patients who underwent TIPS alone had better survival that patients with BCS who required liver transplantation (LTx) (p = 0.003). Conclusions: In our study TIPS provided a highly effective treatment option for BCS patients. The long-term favourability of the outcome was not impacted by the need for repeated TIPS revision. Use of covered stents was instrumental in reducing shunt dysfunction rates. Prospective and larger studies are needed to further optimize therapeutic strategies in this challenging population. Full article

Previous reports showed that prolonged operative time increases the risk of surgical site infection rates, prolonged hospital stays, and potentially higher rates of revision surgeries. In the context of rhinoplasty, the type of nasal deformity may complicate the surgical procedure and increase the operative time. We aimed to investigate the association between the type of nasal deformity and operative time in rhinoplasty patients. This retrospective chart review studies 349 patients who underwent primary and secondary rhinoplasty procedures due to various nasal deformities in King Saud University-Medical City. The primary outcome of the present study was the association between operative time, defined as the time from the initial incision to the completion of skin closure, and the type of nasal deformity. The association between the type of deformity and operative time was assessed using one-way ANOVA and Bonferroni post hoc analysis. There was a statistically significant association between the type of nasal deformity and operative time (p < 0.001). Patients with dorsal, alar base, and tip deformities had significantly longer operative times than patients with isolated dorsal deformities (208.01 ± 57.73 min) (p < 0.001). The analysis also showed that the presence of crooked nose deformities (p < 0.001), an inverted V deformity (p = 0.01), internal nasal valve collapse (p = 0.025), axis deviation (p = 0.003), over-projection, and under-projection significantly increased surgical duration. The complexity of nasal deformities significantly impacts the operative time in rhinoplasty surgeries; more complex deformities that require extensive surgical procedures are associated with a longer operative time. Further research is warranted to corroborate these findings and investigate other potential influencing factors. Full article

Objectives: The EQ-TIPS was developed to measure the Health-Related Quality of Life in infants/toddlers. Considering the rapid development in this period, this study aimed to investigate age-related variations in EQ-TIPS performance. Methods: Data from 551 infants/toddlers living with a health condition were analysed. Infants/toddlers were grouped by age: 0–6 months (n = 100), 6–12 months (n = 95), 12–24 months (n = 147), and 36–48 months (n = 97). Differences in item responses and item correlations across age groups were calculated by Kruskal–Wallis and Spearman’s correlations, respectively. Results: The report of problems was significantly higher for movement, play, and communication in the 36–48-month group compared to the 0–6-month group. There were strong correlations (r > 0.50) across all age groups between play and movement and communication and social interaction/play; neither pain nor eating showed a clear pattern of association. Conclusions: There is an age-related difference in the reporting of items linked to developmental milestones (movement, play, and communication) with most problems reported in the 36–48-month group when deviation from peers and continued dependence on caregivers is notable. Consideration should be given to including broader examples of play in the EQ-TIPS. Redefining the items to represent social communication and/or (social) emotion, rather than communication and social interaction, may be warranted. Future research should explore the psychometric performance of items to further inform item inclusion and/or revision. Full article

Background and Objectives: Anastomotic insufficiencies (AI) and perforations of the upper gastrointestinal tract (uGIT) result in high morbidity and mortality. Endoscopic stent placement and endoluminal vacuum therapy (EVT) have been established as surgical revision treatment options. The Eso-Sponge^® is the only licensed EVT system with limitations in treating small defects (<10 mm). Therefore, a fistula sponge (FS) was developed for the treatment of such defects as a new therapeutic approach. The aim of this study was to evaluate both EVT options’ indications, success rates, and complications in a retrospective, comparative approach. Materials and Methods: Between 01/2018 and 01/2021, the clinical data of patients undergoing FS-EVT or conventional EVT (cEVT; Eso-Sponge^®, Braun Melsungen, Melsungen, Germany) due to AI/perforation of the uGIT were recorded. Indication, diameter of leakage, therapeutic success, and complications during the procedure were assessed. FSs were prepared using a nasogastric tube and a porous drainage film (Suprasorb^® CNP, Lohmann & Rauscher, Rengsdorf, Germany) sutured to the distal tip. Results: A total of 72 patients were included (20 FS-EVT; 52 cEVT). FS-EVT was performed in 60% suffering from AI (cEVT = 68%) and 40% from perforation (cEVT = 32%; p > 0.05). FS-EVT’s duration was significantly shorter than cEVT (7.6 ± 12.0 d vs. 15.1 ± 14.3 d; p = 0.014). The mean diameter of the defect was 9 mm in the FS-EVT group compared to 24 mm in cEVT (p < 0.001). Therapeutic success was achieved in 90% (FS-EVT) and 91% (cEVT; p > 0.05). Conclusions: EVT comprises an efficient treatment option for transmural defects of the uGIT. In daily clinical practice, fistulas < 10 mm with large abscess formations poses a special challenge since intraluminal cEVT usually is ineffective. In these cases, the concept of extraluminal FS placement is safe and effective. Full article

Understanding phenotype variation is among the central topics in biology. We revise and reanalyze studies of the amphipod genus Niphargus to confront two potential mechanisms driving its phenotype variation, namely, cladogenesis and adaptive evolution. We found evidence for both mechanisms. Reanalysis of a subset of traits using molecular phylogeny showed moderate phylogenetic signal, consistent with the hypothesis that overall phylogenetic variation increases with phylogeny. The phylogenetic signal in Niphargus traits seems to be stronger at the tips of the phylogeny than at basal splits. Indirect evidence suggests that much of the phenotype variation can be attributed to adaptive evolution. Both lines of evidence are consistent with the hypothesis that Niphargus evolved in several adaptive radiations, where theory predicts that most of the phenotype variation evolves early, when ecological niches are vacant. As the niches fill up, the rate of phenotype variation slows down and becomes associated with cladogenetic events. This hypothesis can explain the high level of trait-convergence and unresolved taxonomy above the species level. The main caveats to these hypotheses comprise lack of experimental evidence for trait function and nonquantified heritable component of trait variation. Promising venues towards better understanding of phenotypic variation include studies of ontogenetic variation, functional interactions between traits, and genome–phenotype associations. Full article

A remarkable new deep-water skate, Leucoraja longirostris n. sp., is described based on eight specimens caught during different expeditions to the southern Madagascar Ridge in the southwestern Indian Ocean. The new species differs from all congeners by its remarkably long and acutely angled snout (horizontal preorbital length 17.2–22.6% TL vs. 8.5–11.9% TL and 4.2–6.1 vs. 1.7–3.5 times orbit length, snout angle 65–85° vs. 90–150°). Furthermore, it is apparently endemic to the Madagascar Ridge, distant from the known distribution areas of all congeners. In addition to L. fullonica and L. pristispina, L. longirostris n. sp. is also the only species with plain dorsal coloration. Furthermore, the new species is the only Leucoraja species with an external clasper component dike and, besides L. wallacei, the only one with four dorsal terminal (dt) cartilages. The shape of the accessory terminal 1 (at1) cartilage with four tips is also unique within the genus. A new approach for the visualization of the clasper characters is introduced based on 3D models of all skeletal and external features. This enables a much easier and much more precise interpretation of every single clasper component, of the entire structure, and, in particular, the relationship between external features and skeletal cartilages. A new English translation of the first diagnosis of Leucoraja is provided, along with a revised generic diagnosis and a key to the species of Leucoraja in the Indian Ocean. Full article

Study Design: Retrospective cohort study. Objective: To determine patient, defect, and surgical factors associated with facial reconstructive outcomes. Methods: Post-Mohs Micrographic Surgery (MMS) facial reconstructions performed at a single institution between 2015–2020 were reviewed. Patient demographics, comorbidities, defect characteristics, type and timing of reconstruction, and postoperative complications and revisions were collected. Data was analyzed with multivariable logistic regressions. Results: 245 defects in 220 patients (median age 66 years, 143 (65%) female) were included. Most were located on the nose (68%), and median size was 3.0 cm² (IQR 1.32–7.5 cm²). Defect size over 10 cm² (OR 5.176, 95% CI 1.353–19.808) and two-staged melolabial flaps (OR 4.021, 95% CI 1.525–10.603) were associated with complications after univariate analysis. Nasal tip defects (OR 2.324, 95% CI 1.076–5.019) were associated with minor revisions. Major revisions were associated with nasal sidewall (OR 2.873, 95% CI 1.125–7.336) and tip (OR 2.780, 95% CI 1.145–6.749) defects, ear cartilage grafts (OR 3.373, 95% CI 1.382–8.231), two-staged paramedian forehead flaps (OR 19.273, 95% CI 6.864–54.112), and delayed reconstruction over 14 days (OR 5.727, 95% CI 1.298–25.281). On multivariable analysis, defect size over 10 cm² (aOR 4.972, 95% CI 1.286–19.073) and two-staged melolabial flaps (aOR 4.575, 95% CI 1.628–12.857) were independently associated with complications, while two-staged paramedian forehead flaps (aOR 14.421, 95% CI 3.976–52.310) were independently associated with major revisions. Conclusions: More complex reconstructions with larger defects and interpolated flaps were associated with revision surgery and complications of facial reconstruction following MMS. Full article

Background: Cylindrical fully-coated cobalt-chromium stems (CCS) have been widely used in femoral revisions. However, monoblock fluted conical tapered stems (FCTS) are growing in popularity. The present study seeks to determine whether there are any long-term differences between the two designs. Material and methods: A retrospective study of 38 CCS versus 40 FCTS was carried out. Demographic data, clinical variables and radiographic parameters were recorded. Results: Demographic data were comparable. A greater proportion of septic revisions, periprosthetic fractures and previous osteosynthesis failures was observed with FCTS versus CCS (p = 0.012). A greater use of FCTS was recorded in cases with bone defects of type IIIA and higher (p = 0.025). There were no significant differences in terms of in-hospital complications (p = 0.815), postoperative surgical complications or need for reoperation (p = 0.156). The CCS group presented a higher percentage of clinical thigh pain at the end of follow-up (p = 0.006). Additionally, a greater presence of radiolucencies was observed with CCS, especially in proximal zones (1, 7, 10 and 14). More subsidence, tip cortical hypertrophy and stress shielding were recorded in the CCS group. The overall survival at 120 months was 84.2% in the CCS group and 85% in the FCTS group (p = 0.520). When analyzing isolated aseptic loosening as the cause of failure, the survival rate was 94.7% in the CCS group and 95% in the FCTS group (p = 0.506). Conclusions: Both FCTS and CCS with diaphyseal anchorage afford excellent long-term survival rates, with no differences between the two designs. However, a higher incidence of stress shielding, radiolucencies and thigh pain with CCS seems to favor the use of FCTS. Full article

Endoscopic combined intrarenal surgery (ECIRS) provides simultaneous retrograde and percutaneous access to the upper urinary tract. The purpose of this study is to present revised data, tips and tricks, and technique modifications arising from our five-year experience with ECIRS. The data of 62 patients who underwent nonpapillary prone ECIRS from January 2019 to November 2023 were prospectively collected. All cases were performed in the prone position. Inclusion criteria were complex stone cases with stones in multiple calyces requiring either multiple accesses or multiple sessions to achieve stone-free status. Patients’ mean age was 54.4 ± 12.39 years, while the mean stone size was 39.03 ± 13.93 mm. The mean operative time was 51.23 ± 17.75 min. Primary and final stone-free rates were 83.8% and 90.3%, respectively. In total, nine patients presented with postoperative complications, which were all Grade II ones. The holmium-YAG laser type during retrograde lithotripsy was associated with significantly shorter operative times compared to the thulium fiber laser. Nonpapillary prone ECIRS is a feasible, safe, and efficient approach for patients with specific stone and anatomy characteristics. The implementation of more, higher-evidence studies is of utmost importance so that safer conclusions can be drawn. Full article

Machine learning is a crucial tool for both academic and real-world applications. Classification problems are often used as the preferred showcase in this space, which has led to a wide variety of datasets being collected and utilized for a myriad of applications. Unfortunately, there is very little standardization in how these datasets are collected, processed, and disseminated. As new learning paradigms like lifelong or meta-learning become more popular, the demand for merging tasks for at-scale evaluation of algorithms has also increased. This paper provides a methodology for processing and cleaning datasets that can be applied to existing or new classification tasks as well as implements these practices in a collection of diverse classification tasks called USC-DCT. Constructed using 107 classification tasks collected from the internet, this collection provides a transparent and standardized pipeline that can be useful for many different applications and frameworks. While there are currently 107 tasks, USC-DCT is designed to enable future growth. Additional discussion provides explanations of applications in machine learning paradigms such as transfer, lifelong, or meta-learning, how revisions to the collection will be handled, and further tips for curating and using classification tasks at this scale. Full article