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Early pancreatic cancer diagnosis is crucial for timely intervention and better outcomes. The coronavirus disease 2019 (COVID-19) pandemic has disrupted routine health care globally. The COVID-19 pandemic has disrupted routine health care globally. This study aimed to evaluate the impact of COVID-19 on the diagnosis and treatment of pancreatic cancer. This retrospective study compared pancreatic cancer patients from 2 tertiary hospitals in pre and COVID-19 periods. Pre-COVID-19 period spanned from January 1, 2018, to January 19, 2020, while the COVID-19 period extended from January 20, 2020, to December 31, 2021. Results: A total of 542 patients were included. In the pre-COVID-19 period, 280 new cases of pancreatic cancer were enrolled, compared to 262 during COVID-19. The annual incidence rates were 136.63 and 134.50 patients, respectively. The median age was significantly lower during COVID-19 (71.5 years) compared to pre-COVID-19 (77 years) (P < .001). In subgroup analyses for stage 3 and 4, the proportion of stage 4 pancreatic cancer increased during COVID-19 (χ2 = 5.53, P = .019), and the COVID-19 group had younger diagnoses, better performance status, more surgery, higher use of FOLFIRINOX chemotherapy, fewer hospital referrals, and better median overall survival compared to the pre-COVID-19 group. This study revealed changes in the characteristics and treatment of patients diagnosed with pancreatic cancer during the COVID-19 pandemic. Although further large-scale research is necessary, the findings of this study can function as foundational data for formulating policies for the management of patients with pancreatic cancer during future pandemics of other infectious diseases.
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COVID-19 , Neoplasias Pancreáticas , Humanos , Neoplasias Pancreáticas/terapia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/epidemiología , COVID-19/epidemiología , COVID-19/diagnóstico , COVID-19/terapia , Masculino , Femenino , Anciano , Estudios Retrospectivos , Persona de Mediana Edad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , SARS-CoV-2 , Fluorouracilo/uso terapéutico , Fluorouracilo/administración & dosificación , Estadificación de Neoplasias , Incidencia , Irinotecán/uso terapéutico , Oxaliplatino/uso terapéutico , Anciano de 80 o más Años , Leucovorina/uso terapéutico , Turquía/epidemiologíaRESUMEN
Applying machine-learning techniques for imbalanced data sets presents a significant challenge in materials science since the underrepresented characteristics of minority classes are often buried by the abundance of unrelated characteristics in majority of classes. Existing approaches to address this focus on balancing the counts of each class using oversampling or synthetic data generation techniques. However, these methods can lead to loss of valuable information or overfitting. Here, we introduce a deep learning framework to predict minority-class materials, specifically within the realm of metal-insulator transition (MIT) materials. The proposed approach, termed boosting-CGCNN, combines the crystal graph convolutional neural network (CGCNN) model with a gradient-boosting algorithm. The model effectively handled extreme class imbalances in MIT material data by sequentially building a deeper neural network. The comparative evaluations demonstrated the superior performance of the proposed model compared to other approaches. Our approach is a promising solution for handling imbalanced data sets in materials science.
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Objective: Lingual fixed retainers, made from 0.0175-inch 3-strand twisted stainless steel wire (TW) and 0.016 × 0.022-inch straight rectangular wire (RW), are generally used in clinical practice. This study aimed to calculate their accuracy by comparing the discrepancy between computer-aided customized retainers made from these two types of wires. Methods: Eleven orthodontic patients were selected, resulting in 22 maxillary and mandibular three-dimensional printing dental models. Two types of lingual fixed retainers were bonded from canine to canine. To determine the accuracy, five points were chosen for each model, resulting in 110 selected points. The absolute values of the distances on the x-, y-, and z-axes were measured to compare the accuracy of the two types of computer-aided retainers. Results: The accuracy of the two types of retainers did not differ significantly in the x- and z-axes, but only in the y-axis (P < 0.01), where RW-fixed retainers exhibited a slightly but significantly increased distance compared to the TW. Conclusions: Both types of retainers showed high accuracy; however, RW had a slight but statistically significant difference along the y-axis compared with TW. This type of computer-aided design/computer-aided manufacturing bending machine is limited to two dimensions, and the dental arch is curved. Therefore, RW may require slight manual adjustment by the practitioner after manufacturing.
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Endoscopic ultrasound (EUS)-guided interventions have evolved rapidly in recent years, with dedicated metal stents playing a crucial role in this process. Specifically, the invention of biflanged short metal-covered stents, including lumen-apposing metal stents (LAMS), and modifications in a variety of tubular self-expandable metal stents (SEMS), have led to innovations in EUS-guided interventions. LAMS or non-LAMS stents are commonly used in the EUS-guided drainage of pancreatic fluid collections, especially in cases of walled-off necrosis. Additionally, LAMS is commonly considered for drainage of the EUS-guided gallbladder or dilated common bile duct and EUS-guided gastroenterostomy. Fully or partially covered tubular SEMS with several new designs are being considered for EUS-guided biliary drainage. This review focuses on advances in SEMS for EUS-guided interventions and discusses related research results.
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This study retrospectively evaluated the outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using novel electrocautery-enhanced lumen-apposing metal stents (LAMS) in high-risk patients with acute cholecystitis (AC). Between January 1, 2021, and November 30, 2022, 58 high-risk surgical patients with AC underwent EUS-GBD with the novel electrocautery-enhanced LAMS. The technical success rate was 94.8% (55/58), with one case of duodenal perforation requiring surgery with complete stent migration and two of partial stent migration into the gallbladder. However, the clinical success rate was 100% (55/55). Recurrent AC occurred in 3.6% of the cases (2/55), managed with double pigtail plastic stents through the LAMS. Early AEs observed in 1.8% (1/55) due to stent obstruction. Late AEs occurred in 5.4% (3/55), including two cases of cholangitis and one of stent obstruction. For 33 patients followed over 6 months, LAMS maintenance was sustained in 30 cases. Two patients underwent double-pigtail plastic stent replacement after LAMS removal, and one underwent LAMS removal during surgery following tumor stage regression after chemotherapy for cholangiocarcinoma. The novel electrocautery-enhanced LAMS demonstrated high technical and clinical success rates in high-risk surgical patients with AC, maintaining effective gallbladder drainage with minimal AEs during long-term follow-up, thus highlighting its efficacy and safety in challenging patients.
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Drenaje , Electrocoagulación , Endosonografía , Vesícula Biliar , Stents , Humanos , Masculino , Femenino , Drenaje/métodos , Anciano , Electrocoagulación/métodos , Endosonografía/métodos , Persona de Mediana Edad , Estudios Retrospectivos , Vesícula Biliar/cirugía , Anciano de 80 o más Años , Resultado del Tratamiento , Colecistitis Aguda/cirugía , AdultoRESUMEN
INTRODUCTION: Aggressive hydration using lactated Ringer's solution prevents postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Concerns of this strategy are large volume and lengthy hydration. Our study aimed to evaluate the efficacy of tailored aggressive hydration (TAH) for PEP prevention. METHODS: In this prospective, multicenter, double-blinded, randomized trial conducted across 3 tertiary Korean hospitals, patients who underwent ERCP for the first time were randomly assigned (1:1) to the tailored standard hydration (TSH) and TAH groups. The TSH group received 1.5 mL/kg/hr lactated Ringer's solution during and after ERCP, whereas the TAH group was administered a 20 mL/kg bolus post-ERCP and 3 mL/kg/hr during and after the procedure. Both groups were assessed for elevated serum amylase levels and pain 4-6 hours after ERCP. If both were absent, hydration was discontinued. If either was present, hydration was continued at the original rate until 8 hours. The primary end point was PEP development and was analyzed on an intention-to-treat analysis. RESULTS: A total of 344 patients were randomly assigned to treatment groups (171 to the TSH group and 172 to the TAH group). PEP was observed in 9.4% (16/171) in the TSH group and 3.5% (6/172) in the TAH group (relative risk 0.37, 95% confidence interval 0.15-0.93, P = 0.03). No difference was identified between the 2 groups in PEP severity ( P = 0.80) and complications related to volume overload ( P = 0.32). DISCUSSION: TAH according to the presence of abdominal pain or elevated serum amylase levels at 4-6 hours after ERCP is safe and prevents PEP development.
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BACKGROUND: Although lumen-apposing metal stents (LAMSs) have been increasingly used for walled-off necrosis (WON), their advantages over plastic stents in infected WON are unclear. We investigated the safety and efficacy of a novel electrocautery-enhanced LAMS for managing infected WON. METHODS: Patients who required endoscopic ultrasound-guided WON drainage were randomly assigned to LAMS or plastic stent groups. The primary outcome was total number of direct endoscopic necrosectomy (DEN) procedures required to achieve clinical success. Secondary outcomes included rates of technical success, clinical success, and adverse events. RESULTS: 46 patients were included in the LAMS (n = 23) and plastic stent (n = 23) groups. The median total number of DEN procedures did not differ significantly between the plastic stent group (4 procedures, interquartile range [IQR] 2.5-5.0) and LAMS group (9 procedures, IQR 8.0-9.0) (P = 0.07). The LAMS group demonstrated a significantly higher clinical success rate than the plastic stent group based on intention-to-treat analysis (100% vs. 73.9%, P =0.03) at 8 weeks but not at 4 weeks. Significant bleeding occurred in one patient in the plastic stent group and no patients in the LAMS group. CONCLUSIONS: We found no significant difference in the total number of DEN procedures between LAMSs and plastic stents for managing infected WON. The only statistically significant finding was a higher clinical success rate at 8 weeks for patients treated with LAMS. The use of LAMS did not result in any adverse events, such as bleeding or buried LAMS syndrome, within the study duration.
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Background/Aims: : Acute pancreatitis (AP) is a leading cause of emergency hospitalization. We present the current diagnostic and therapeutic status of AP as revealed by analysis of a large multicenter dataset. Methods: : The medical records of patients diagnosed with AP between 2018 and 2019 in 12 tertiary medical centers in Korea were retrospectively reviewed. Results: : In total, 676 patients were included; of these, were 388 (57.4%) males, and the mean age of all patients was 58.6 years. There were 355 (52.5%), 301 (44.5%), and 20 (3.0%) patients with mild, moderate, and severe AP, respectively, as assessed by the revised Atlanta classification. The most common etiologies of AP were biliary issues (41.6%) and alcohol consumption (24.6%), followed by hypertriglyceridemia (6.8%). The etiology was not identified in 111 (16.4%) patients at the time of initial admission. The overall mortality rate was 3.3%, increasing up to 45.0% among patients with severe AP. Notably, 70.0% (14/20) of patients with severe AP and 81.5% (154/189) of patients with systemic inflammatory response syndrome had received <4 L per day during the initial 24 hours of admission. Only 23.8% (67/281) of acute biliary pancreatitis patients underwent cholecystectomy during their initial admission. In total, 17.8% of patients experienced recurrent attacks during follow-up. However, none of the patients with acute biliary pancreatitis experienced recurrent attacks if they had undergone cholecystectomy during their initial admission. Conclusions: : This study provides insights into the current status of AP in Korea, including its etiology, severity, and management. Results: reveal disparities between clinical guidelines and their practical implementation for AP treatment.
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Background: Glenoid position and inclination are important factors in protecting against scapular notching, which is the most common complication that directly affects the longevity of reverse shoulder arthroplasty (RSA). This study aimed to investigate the biomechanical characteristics of glenosphere orientation, comparing neutral tilt, inferior overhang with an eccentric glenosphere at the same placement of baseplate, and inferior tilt after 10° inferior reaming in the lower part of the glenoid in RSA. Methods: Nine cadaveric shoulders were tested with 5 combinations of customized glenoid components: a centric glenosphere was combined with a standard baseplate (group A); an eccentric glenosphere to provide 4-mm inferior overhang than the centric glenosphere was combined with a standard baseplate (group B); a centric glenosphere was combined with a wedge-shaped baseplate tilted inferiorly by 10° with the same center of rotation (group C); an eccentric glenosphere was attached to a wedge-shaped baseplate (group D); and 10° inferior reaming was performed on the lower part of the glenoid to apply 10° inferior tilt, with a centric glenosphere secured to the standard baseplate for simulation of clinical tilt (group E). Impingement-free angles for adduction, abduction, forward flexion, external rotation, and internal rotation were measured. The capability of the deltoid moment arm for abduction and forward flexion, deltoid length, and geometric analysis for adduction engagement were evaluated. Results: Compared with neutral tilt, inferior tilt at the same position showed no significant difference in impingement-free angle, moment arm capability, and deltoid length. However, group D resulted in better biomechanical properties than a central position, regardless of inferior tilt. Group E demonstrated a greater range of adduction, internal and external rotation, and higher abduction and forward flexion capability with distalization, compared to corresponding parameters for inferior tilt with a customized wedge-shaped baseplate. Conclusions: A 10° inferior tilt of the glenosphere, without changing the position of the baseplate, had no benefit in terms of the impingement-free angle and deltoid moment arm. However, an eccentric glenosphere had a significant advantage, regardless of inferior tilt. Inferior tilt through 10° inferior reaming showed better biomechanical results than neutral tilt due to the distalization effect.
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Artroplastía de Reemplazo de Hombro , Articulación del Hombro , Prótesis de Hombro , Humanos , Artroplastía de Reemplazo de Hombro/métodos , Articulación del Hombro/cirugía , Hombro/cirugía , Escápula , Rango del Movimiento Articular , Fenómenos BiomecánicosRESUMEN
Backgrounds/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions: The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.
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Background: Endoscopic ultrasound-guided biliary drainage (EUS-BD), classified as choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS), is a feasible and effective alternative for distal malignant biliary obstruction (MBO) in failed endoscopic retrograde cholangiopancreatography. However, the preferred technique for better outcomes has not yet been evaluated. Objectives: We compared the long-term outcomes between the techniques. Design: Retrospective comparative study. Methods: We reviewed consecutive patients who underwent EUS-CDS or EUS-HGS with transmural stent placement for distal MBO between 2009 and 2022. The primary outcome was the stent patency. The secondary outcomes were technical and clinical success, adverse events (AEs) of each technique, and independent risk factors for stent dysfunction. Results: In all, 115 patients were divided into EUS-CDS (n = 56) and EUS-HGS (n = 59) groups. Among them, technical success was achieved in 98.2% of EUS-CDS and 96.6% of EUS-HGS groups. Furthermore, clinical success was 96.4% in EUS-CDS and 88.1% in EUS-HGS groups, without significant difference (p = 0.200). The mean duration of stent patency for EUS-CDS was 770.3 days while that for EUS-HGS was 164.9 days (p = 0.010). In addition, the only independent risk factor for stent dysfunction was systematic treatment after EUS-BD [hazard ratio and 95% confidence interval 0.238 (0.066-0.863), p = 0.029]. The incidence of stent dysfunction of EUS-HGS was higher than EUS-CDS (35.1% versus 18.2%, 0.071), despite no significant differences even in late AEs. Conclusion: In distal MBO, EUS-CDS may be better than EUS-HGS with longer stent patency and fewer AEs. Furthermore, systematic treatment after EUS-BD is recommended for the improvement of stent patency.
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Background: Many older adults with glenohumeral osteoarthritis without rotator cuff tears experience muscle atrophy and fatty degeneration. In these cases, range of motion (ROM) recovery and clinical results after total shoulder arthroplasty (TSA) could be poor, with low subjective satisfaction after surgery. The purpose of this study was to compare the clinical outcomes of anatomic TSA and reverse shoulder arthroplasty (RSA) in patients aged over 70 years with primary glenohumeral osteoarthritis without rotator cuff tears. We hypothesized that the clinical outcomes of anatomical TSA would be better than those of RSA. Methods: This single-center, retrospective comparative study involved patients who underwent TSA or RSA from 2013 to 2020. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and active ROM preoperatively and at the follow-up. Walch classification and glenoid version angle were measured using preoperative computed tomography, and fatty infiltration of supraspinatus and infraspinatus muscles were checked through preoperative magnetic resonance imaging. Results: Of the 67 patients included in this study, TSA was performed in 41 patients (TSA group), and RSA was performed in 26 patients (RSA group). The two groups had no clinical differences in the patients' preoperative demographic and radiographic data. At the final follow-up, both groups showed improved pain, ROM, and functional outcomes. Moreover, the TSA group demonstrated significantly better postoperative ASES (86.8 ± 6.3 vs. 81.6 ± 5.5, p = 0.001) and Constant-Murley (80.4 ± 5.7 vs. 73.4 ± 6.2, p < 0.001) scores than the RSA group. The TSA group showed a significantly better postoperative active ROM than the RSA group regarding forward flexion as well as external and internal rotations (p < 0.001). All patients in the RSA and TSA groups exceeded the minimal clinically important difference. Conclusions: In older adult patients with degenerative glenohumeral osteoarthritis wherein the rotator cuff is preserved without excessive bone loss, anatomic TSA and RSA can improve pain, ROM, and clinical outcomes. However, clinical results and ROM were better with TSA than with RSA during the short- and mid-term follow-up periods.
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Artroplastía de Reemplazo de Hombro , Osteoartritis , Lesiones del Manguito de los Rotadores , Articulación del Hombro , Humanos , Anciano , Anciano de 80 o más Años , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/cirugía , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/cirugía , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Dolor/cirugía , Rango del Movimiento ArticularRESUMEN
Since its development, the use of endoscopic ultrasonography (EUS) in the pancreas and the biliary tract has become increasingly important. The accuracy of EUS varies depending on the experience of the endoscopist. Hence, quality control measures using appropriate indicators are required to reduce these variations. American Society for Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy have announced the EUS quality indicators. Here, we reviewed the quality indicators of the EUS procedure in the current published guidelines.
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Background/Aims: Based on their anatomy, cholangiocarcinomas (CCAs) are classified into intrahepatic, hilar, and distal CCAs. Although the diagnosis and treatment of each type of CCA are thought to be different, real-world data studies on the current practice are limited. Therefore, this study was designed to capture the current practice of diagnosing and treating perihilar CCA in Korea. Methods: We conducted a survey using an online platform. The questionnaire consisted of 18 questions designed to evaluate the current practice of diagnosing and treating perihilar CCA in Korea. The targets of this survey were biliary endoscopists who are members of the Korean Pancreatobiliary Association. Results: In total, 119 biliary endoscopists completed the survey. Of the respondents, 89.9% thought that the use of the International Classification of Diseases, 11th Revision (ICD-11) system is necessary to classify CCA. Approximately half of the respondents would recommend surgery or chemotherapy until patients were 80 years of age. For the pathological diagnosis of CCA, endoscopic retrograde cholangiopancreatography with biopsy was the most preferred modality. Routine preoperative biliary drainage was performed by 44.5% of the respondents. For operable CCAs, 64.7% of the respondents preferred endoscopic biliary drainage using plastic stents. For palliative biliary drainage, 69.7% of the respondents used plastic stents. For palliative endoscopic biliary drainage using metal stents, 63% of the respondents preferred the stent-in-stent method. Conclusions: A new coding system using the ICD-11 is needed for classifying CCAs. Guidelines for diagnosing and treating CCA based on the clinical situation in Korea are needed.
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Neoplasias de los Conductos Biliares , Colangiocarcinoma , Tumor de Klatskin , Humanos , Tumor de Klatskin/diagnóstico , Tumor de Klatskin/terapia , Neoplasias de los Conductos Biliares/diagnóstico , Neoplasias de los Conductos Biliares/terapia , Neoplasias de los Conductos Biliares/patología , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/terapia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Drenaje/métodos , Stents , Conductos Biliares Intrahepáticos/cirugía , República de CoreaRESUMEN
PURPOSE: To compare the clinical outcomes and tendon integrity after rotator cuff repair combined with anterior cable reconstruction (ACR) using the proximal biceps tendon and patch augmentation (PA) using a human dermal allograft (HDA) in a large retracted anterior rotator cuff tear. METHODS: Patients who underwent arthroscopic rotator cuff repair with 2 different augmentation procedures between January 2017 and December 2020 were enrolled. The inclusion criteria were patients who were treated by arthroscopic rotator cuff repair with ACR using the proximal biceps tendon (ACR group) or patch augmentation using a an HDA (PA group) and follow-up for at least 2 years. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) score, Constant score, and the number of patients who achieved minimal clinically important differences (MCID). Magnetic resonance imaging was performed to evaluate tendon integrity after surgery. RESULTS: A total of 92 patients were enrolled (ACR group = 55 patients and PA group = 37 patients). The mean ASES and Constant scores significantly improved in the ACR group (68.8 ± 15.3 and 58.4 ± 16.9 before surgery vs 91.4 ± 6.3 and 87.8 ± 6.0 after surgery, P < .001) and in the PA group (63.7 ± 16.7 and 57.9 ± 15.4 before surgery vs 93.1 ± 6.3 and 88.3 ± 6.2 after surgery, P < .001). Overall, 78 patients (84.8%) achieved the MCID with 81.8% in the ACR group and 89.2% in the PA group, with no significant differences between the 2 groups (P = .638). Ten patients (18.2%) had retear in the ACR group, and three patients (8.1%) had retear in the PA group (P = .174). CONCLUSIONS: In large retracted anterior rotator cuff tears, both augmentation techniques using biceps tendon autograft and HDA provided satisfactory clinical outcomes that achieved the MCID in 84.8%, range of motion restoration, and lower retear rates with no significant differences between the two groups. LEVEL OF EVIDENCE: Level III, retrospective case-control study.
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Lesiones del Manguito de los Rotadores , Humanos , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/patología , Manguito de los Rotadores/cirugía , Manguito de los Rotadores/patología , Estudios Retrospectivos , Codo , Estudios de Casos y Controles , Autoinjertos , Tendones/cirugía , Tendones/patología , Imagen por Resonancia Magnética , Aloinjertos/patología , Resultado del Tratamiento , Artroscopía/métodos , Rango del Movimiento ArticularRESUMEN
Background/Aims: There are no consensus guidelines for patients with acute cholecystitis undergoing percutaneous cholecystostomy who are unfit for interval cholecystectomy. The current study aimed to compare the clinical outcomes of endoscopic gallbladder drainage, i.e. conversion from percutaneous cholecystostomy (including endoscopic transpapillary gallbladder stenting and endoscopic ultrasound-guided gallbladder drainage), and conservative treatment after percutaneous cholecystostomy tube removal. Methods: This retrospective review included patients who underwent percutaneous cholecystostomy for acute cholecystitis between January 2017 and December 2020. Consecutive patients who underwent endoscopic gallbladder drainage or percutaneous cholecystostomy tube removal without interval cholecystectomy were included. Outcome measures included recurrent acute cholecystitis and unplanned readmission due to gallstone-related diseases. Results: During the study period, 238 patients were selected (63 underwent endoscopic gallbladder drainage conversion and 175 underwent conservative treatment). Patients who underwent endoscopic gallbladder drainage conversion had lower rates of recurrent acute cholecystitis (3 [4.76%] vs 31 [17.71%], p=0.012) and unplanned readmission due to gallstone-related diseases (6 [9.52%] vs 40 [22.86%], p=0.022) than those who underwent conservative treatment following percutaneous cholecystostomy tube removal. In the univariate and multivariate analyses, calculus cholecystitis (odds ratio, 13.75; 95% confidence interval, 1.83 to 102.83; p=0.011) and conversion of endoscopic gallbladder drainage (odds ratio, 0.23; 95% confidence interval, 0.06 to 0.78; p=0.019) were significant predictive factors for recurrent acute cholecystitis. Conclusions: Endoscopic gallbladder drainage conversion led to more favorable outcomes than conservative treatment after percutaneous cholecystostomy tube removal. Therefore, endoscopic gallbladder drainage conversion may be considered a promising treatment option for patients undergoing percutaneous cholecystostomy who are at a high surgical risk.
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Colecistitis Aguda , Colecistostomía , Cálculos Biliares , Humanos , Vesícula Biliar/cirugía , Colecistostomía/efectos adversos , Tratamiento Conservador , Cálculos Biliares/cirugía , Drenaje/efectos adversos , Colecistitis Aguda/cirugía , Colecistitis Aguda/etiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
A 60-year-old woman presented functional deficit of the index finger flexor digitorum profundus (FDP) tendon after shoulder arthroscopic rotator cuff repair. As no recovery was observed for 10 months, we conducted an operative exploration of the median nerve and the anterior interosseous nerve, followed by an external neurolysis. The patient recovered FDP function 4.5 months after the second operation. In a patient with persistent isolated FDP dysfunction after shoulder arthroscopy, operative exploration and external neurolysis could facilitate functional recovery. Level of Evidence: Level V (Therapeutic).
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Artroscopía , Hombro , Femenino , Humanos , Persona de Mediana Edad , Artroscopía/efectos adversos , Dedos/inervación , Músculo Esquelético , Tendones/cirugía , Tendones/fisiologíaRESUMEN
This study aimed to evaluate the difference in expansion patterns based on the position of miniscrews for a tissue-bone-borne palatal C-expander using a finite element method. Ten expansion models were examined, each representing a different position of miniscrews on the palate. Models A and B had miniscrews symmetrically placed 7 mm and 15 mm below the cementoenamel junction (CEJ), respectively. Models C to J had miniscrews positioned in a triangular manner at 7 mm and 15 mm below CEJ. Stress, displacement, angular changes of the bone and teeth, and changes in the nasomaxillary complex were measured using elastoplastic behavior models through static-nonlinear simulation employing an implicit method. The anterior and posterior parts of paramidpalatal suture area were identified as ANT, TPS-M, and TPS-L, and their ratio was assessed. Model A, which featured three miniscrews located 7 mm below the CEJ, exhibited the least molar inclination and the smallest amount of skeletal expansion. Model I, with two miniscrews placed between the first and second molars, demonstrated the greatest lateral displacement at point N on the nasal cavity wall, along with the smallest ratio of ANT to TPS-M or TPS-L. This finding suggests that the posterior expansion of the palate in relation to the anterior expansion was maximized. The results of this study indicate that strategic positioning of miniscrews is effective in achieving various expansion patterns based on the targeted correction areas within the nasomaxillary complex.
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Maxilar , Diente , Maxilar/cirugía , Análisis de Elementos Finitos , Hueso Paladar/cirugía , Diente MolarRESUMEN
Conventional cage and plate (CCP) implants usually used in ACDF surgery, do have limitations such as the development of postoperative dysphagia, adjacent segment degeneration, and soft tissue injury. To reduce the risk of these complications, zero-profile stand-alone cage were developed. We used finite-element modeling to compare the total von Mises stress applied to the bone, disc, endplate, cage and screw when using CCP and ZPSC implants. A 3-dimensional FE (Finite element) analysis was performed to investigate the effects of the CCP implant and ZPSC on the C3 ~ T1 vertebrae. We confirmed that the maximum von Mises stress applied with ZPSC implants was more than 2 times greater in the endplate than that applied with CCP implants. The 3D analysis of the ZPSC model von Mises stress measurements of screw shows areas of higher stress in red. Although using ZPSC implants in ACDF reduces CCP implant-related sequalae such as dysphagia, we have shown that greater von Mises stress is applied to the endplate, and screw when using ZPSC implants. This may explain the higher subsidence rate associated with ZPSC implant use in ACDF. When selecting an implant in ACDF, surgeons should consider patient characteristics and the advantages and disadvantages of each implant type.