Impact of thyroid carcinoma invasion of recurrent laryngeal nerve on cervical lymph node metastasis.

PURPOSE: Papillary thyroid carcinoma (PTC) has a favorable prognosis. However, involvement of the recurrent laryngeal nerve (RLN) significantly increases the risk of recurrence. RLN invasion was an important factor in determining the extent of thyroid surgery. The purpose of this study was to compare clinicopathologic features and characterize risk factors of central and lateral lymph node metastasis (LLNM) of RLN invasion in patients with PTC. METHODS: A retrospective review was conducted of 130 patients with PTCs who had exclusive tumor involvement of the RLN at our institution between January 2014 and February 2019. All patients underwent total thyroidectomy and high-dose radioactive iodine (RAI) therapy. The clinicopathologic factors and prognostic outcomes of the patients with solitary and multiple RLN involvements were compared. Kaplan-Meier method was performed to compare the outcomes of tumor recurrence. Univariate and multivariate logistic regression analyses were used to identify risk factors associated with LLNM. RESULTS: The invasion of the RLN was similar on both sides, with 58.5% on the right, 40.0% on the left, and 1.5% on both sides. Significant differences were observed in tumor size (p < 0.001), lymph node metastasis classification (p = 0.002), RLN resection (p < 0.001), and thyroglobulin (p = 0.010) in the solitary and multiple groups. During the median follow-up of 67 months, 9 (6.9%) patients developed recurrence. There were no statistical differences in recurrence for age, tumor size, gender, multifocality, lymph node metastasis (LNM), and RLN resection. According to receiver operating characteristic (ROC) curve analyses, a cut-off of tumor size > 1.7 cm was identified as the most sensitive and specific predictor of RLN with multiple involvements or LNM invasion. Univariate and multivariate analyses revealed that central lymph node metastasis (CLNM) and RLN invasion by LNM can serve as independent risk factors for LLNM (p = 0.006 and p < 0.001, respectively). CONCLUSION: Our results indicate that recurrence was comparable in patients with solitary and multiple RLN involvements. Multiple RLN involvement was associated with pathological features such as larger tumors, RLN resection, and LLNM. The presence of LNM invading RLN and multiple nerve involvement increases the risk of intraoperative RLN resection. A higher risk of multiple invasion or LNM invasion should be considered when tumor size > 1.7 cm. The presence of CLNM and RLN invaded by LNM were independent predictors for LLNM, which could aid surgeons in deciding on lateral lymph node dissection.

Roles of PTEN gene methylation in Se-CQDs induced mitochondrial apoptosis of osteosarcoma cells.

Biocompatible carbon quantum dots (CQDs) containing anti-osteosarcoma elements are intriguing therapeutics promising for bioimaging and tumor therapy. However, how the anti-osteosarcoma element doped in the structure of such CQDs triggers tumor inhibition remains unclear. Here, selenium-doped CQDs (Se-CQDs) are developed via a one-step hydrothermal route using discarded orange peel as a carbon source and structurally characterized by various physicochemical techniques. The biocompatibility and anti-osteosarcoma efficacy are deeply evaluated using animal and cell models. The resulting spherical Se-CQDs, with a 3-7 nm diameter, possess green-yellow tunable luminescence and excellent biocompatibility. Cell experiments show that Se-CQDs can be up-taken by osteosarcoma U2OS cells and activate the mitochondrial apoptosis pathway triggered by increased reactive oxygen species. They can arrest the cell cycle at the G2/S phase and promote cellular apoptosis with reduced invasion and migration. Molecularly, Se-CQDs can down-regulate the expression of DNMT1 while up-regulating the expression of PTEN due to the decreased promoter methylation. Notably, Se-incorporated CQDs are more effective in inhibiting the proliferation, migration, and invasion of osteosarcoma than Se-free CQDs. It is feasible to use Se-CQDs as candidates for the potential application of early monitoring and treatment of osteosarcoma.

Sternomastoid intermuscular approach has better postoperative cosmesis and less neck discomfort than linea alba cervicalis approach in hemithyroidectomy: a randomized clinical trial.

BACKGROUND: Surgery is still the most important treatment method for thyroid cancer. The classic linea alba cervicalis approach caused obvious neck scarring. This study explored an alternative open operative approach with concealed incision for hemithyroidectomy, and demonstrated whether it was non-inferior to traditional approach in postoperative complications and operation efficiency. METHODS: Patients ( n =220) from November 2019 to November 2020 willing to undergo hemithyroidectomy because of differentiated thyroid cancer were randomly divided into the sternocleidomastoid intermuscular approach (SMIA) group ( n =110), and the linea alba cervicalis approach (LACA) group ( n =110). The incidence of postoperative complications within 3 months and operation efficiency indicator R0 resection rate were recorded as primary endpoint, while scar apperance was assessed as secondary endpoint. The data were statistically analyzed. RESULTS: The baseline data of these two groups were comparable, with no significant difference ( P >0.05). As primary endpoint, R0 resection rate was 100% in both groups. In the 1-month follow-up period, the SMIA group had a lower score for neck discomfort compared with that of the LACA group (1.01±0.1648 vs. 0.5657±0.0976, P =0.0217). The SMIA group's scar had better results from the observer scar assessment compared to that of the LACA group as secondary endpoint. Within the 3-month follow-up, the total complications were calculated, and it was demonstrated that SMIA was non-inferior to traditional LACA operation ( P of non-inferiority=0.0048). CONCLUSIONS: Compared with LACA group, surgery through the SMIA is safe, effective, and has non-inferior postoperative complications. SMIA can be considered an alternative approach to classic LACA in hemithyroidectomy.

Retroperitoneal Nephrometry Scoring System (RETRO) for Minimal-Invasive Partial Nephrectomy.

PURPOSE: To propose a standardized scoring system of renal tumors suitable for partial nephrectomy based on mini-invasiveness and retroperitoneal approach. MATERIALS AND METHODS: One-hundred and five patients in retroperitoneal group were prospectively enrolled from January 2017 to December 2018. Perioperative characteristics of all patients were collected: age, gender, BMI, preoperative blood test and imaging results, operation time (the time period starts from the skin incision to the final skin closure), estimated blood lost, clamping time, complications within 30 days, American Society of Anesthesiologists (ASA) score, pathology. An algorithm was extracted, and it was used to predict the risk of complications. RESULTS: Symptoms, ASA score and RETRO score were significantly correlated to postoperative complications, excluding tumor size, ischemia time and operation time. Adjusted RETRO points were an independent factor to predict complication rate (p = 0.006). Limitation was that it did not analyze the relationship between the RETRO score and the long-term outcomes. CONCLUSION: The RETRO score simplifies the risk evaluation of partial nephrectomy for patients with renal tumor, especially benefits those surgeries performed under robot-assisted laparoscope via retroperitoneal approach. The new RETRO score system that we developed is a selection criterion to perform surgery via different approaches, and an accurate system to evaluate the complexity during partial nephrectomy.

Differences in the clinical characteristics of papillary thyroid microcarcinoma located in the isthmus ≤5 mm and >5mm in diameter.

Background: The optimal treatment of papillary thyroid microcarcinomas (PTMCs) located in the isthmus (iPTMCs) is still controversial. The purpose of this study was to compare the clinicopathologic features of patients with iPTMCs ≤5 mm and >5 mm in diameter after total thyroidectomy, and to identify the risk factors for recurrence in patients with iPTMCs. Methods: A total of 102 iPTMC patients who underwent total thyroidectomy were reviewed retrospectively. The clinicopathologic characteristics of iPTMCs ≤5 mm group (n = 29) have been compared with a group >5 mm (n = 73). Univariate and multivariate Cox proportional hazard models served to identify risk factors associated with recurrence-free survival (RFS). Results: Gender (p = 0.033), multifocality (p = 0.041), and central lymph node metastasis (CLNM) (p = 0.009) of patients in the ≤5 mm and >5 mm groups differed significantly. iPTMC patients with age <55 years, male, multiple tumor, and extrathyroidal extension showed comparatively more frequent of CLNM in >5 mm groups. Of the 102 patients, nine (8.8%) developed recurrence during follow-up (median: 49.5 months). The patients with recurrences had comparatively high rates of CLNM (p = 0.038), extranodal invasion (p = 0.018), and more MNCND (Metastasis Nodes for Central Neck dissection) (p = 0.020). A cutoff of MNCND >2.46 was established as the most sensitive and specific level for the prediction of recurrence based on receiver operating characteristic (ROC) curve analyses. Multivariate analysis showed that the number of MNCND ≥3 was an independent predictor of poor RFS (p = 0.028). Conclusion: We have found that the recurrence rates are similar in patients with iPTMCs ≤5 mm and >5 mm. The iPTMCs >5 mm were more likely to be associated with pathological features such as multifocality and CLNM. The male gender, extrathyroidal extension, and CLNM were associated with recurrence of iPTMCs except for tumor size and multifocality. Higher risk of CLNM should be considered in iPTMC >5 mm when it reaches some risk factors. The numbers of MNCND ≥3 may be an independent predictor for recurrence, which could help clinicians for the decision of radioiodine administration and the modulation of follow-up modalities.

Stem Cell Therapy for Thyroid Diseases: Progress and Challenges.

Background: Thyroid hormones are indispensable for organ development and maintaining homeostasis. Thyroid diseases, including thyroiditis and thyroid cancer, affect the normal secretion of hormones and result in thyroid dysfunction. Objective: This review focuses on therapeutic applications of stem cells for thyroid diseases. Methods: A literature search of Medline and PubMed was conducted (January 2000-July 2021) to identify recent reports on stem cell therapy for thyroid diseases. Results: Stem cells are partially developed cell types. They have the capacity to form specialized cells. Besides embryonic stem cells and mesenchymal stem cells, organ resident stem cells and cancer stem cells are recently reported to have important roles in forming organ specific cells and cancers. Stem cells, especially mesenchymal stem cells, have anti-inflammatory and anticancer functions as well. Conclusions: This review outlines the therapeutic potency of embryonic stem cells, mesenchymal stem cells, thyroid resident stem cells, and thyroid cancer stem cells in thyroid cells' regeneration, thyroid function modulation, thyroiditis suppression, and antithyroid cancers. Stem cells represent a promising form of treatment for thyroid disorders.

Effect of energy metabolism and proteolysis on the toughness of intermediate ultimate pH beef.

The objective of this study was to identify the tenderness and energy metabolism attributes in normal ultimate pH (pHu, 5.4-5.8, NpHu), intermediate pHu (5.8-6.2, IpHu) and high pHu (> 6.2, HpHu) Longissimus lumborum from beef. During 21 days of aging, the IpHu group exhibited a higher Warner-Bratzler shear force, lower activity of µ-calpain, and a higher content of heat shock protein 27 and greater protein oxidation. Metabolomics analysis revealed that 24 differential metabolites were detected during the first 24 h postmortem between pH groups, and these were mainly the products of glycolysis, the tricarboxylic acid (TCA) cycle and oxidative phosphorylation. The relatively higher adenosine triphosphate content in the IpHu group could delay tenderization by being used as key substrate for protein phosphorylation. In addition, the relationship between guanosine triphosphate, diphosphate and monophosphate, and beef tenderness was worthy to be verified in the future study.

SYT7 plays a role in promoting thyroid cancer by mediating HMGB3 ubiquitination.

Thyroid cancer is one of the most common endocrine malignancies. It is necessary to discover more effective molecular targets for the treatment of thyroid cancer. The results of immunohistochemical staining, qPCR and Western blot indicated that the expression of SYT7 in thyroid cancer tissues and cells was higher than that in paracarcinoma tissues and normal thyroid cells. Through cell function testing experiments, it was found that SYT7 knockdown inhibited the proliferation and migration of thyroid cancer cells and promoted cell apoptosis, while SYT7 overexpression had the opposite effect. Similarly, SYT7 downregulation also suppressed tumor growth in vivo. HMGB3 was confirmed to be the downstream gene of SYT7 by GeneChip and Ingenuity Pathway Analysis. Besides, through UbiBrowser database predictions and Co-IP assays, we found that SYT7 interacted with BRCA1 to inhibit HMGB3 ubiquitination and thus upregulated the protein level of HMGB3. Similar to SYT7, HMGB3 was significantly upregulated in thyroid cancer. HMGB3 knockdown inhibited the proliferation and migration of thyroid cancer cells and promoted cell apoptosis. Furthermore, HMGB3 knockdown restored the promotion of cell proliferation and migration caused by SYT7 overexpression. SYT7 and HMGB3 were upregulated in thyroid cancer, and SYT7 regulated the expression of HMGB3 through BRCA1-mediated ubiquitination of HMGB3 to promote thyroid cancer progression.

Effect of chitosan coating incorporated with oregano or cinnamon essential oil on the bacterial diversity and shelf life of roast duck in modified atmosphere packaging.

The present study aimed to investigate the effect of chitosan edible coating containing 0.15% oregano essential oil (OEO) or 0.60% cinnamon essential oil (CEO) on the quality characteristics and dynamic changes in the bacterial community of roast duck slices under modified atmosphere packaging (MAP, 30% CO2/70% N2) during 21 days of storage at 2 ± 2 °C. The results showed that the application of chitosan coating (CH) alone inhibited the growth of microorganisms and prevented lipid oxidation throughout storage. Moreover, the storage stability was further improved by including OEO or CEO, which lowered (P < 0.05) values for total viable count (TVC), Enterobacteriaceae, 2-thiobarbituric acid reactive substance (TBARS) and total volatile basic nitrogen (TVB-N). Based on the microbiological results, the shelf-life of CH-OEO and CH-CEO treated roast duck slices was prolonged by at least 7 days compared to that of the control. In addition, packaging types applied in this study played a major role in the bacterial community development. Notably, Vibrio spp. were the most predominant bacteria in all samples, when TVC values approached the shelf-life threshold, suggesting that this bacterium may be the main contributor to the spoilage of roast duck. The growth inhibition of Vibrio spp. in the CH-OEO and CH-CEO treatments during the early period of chilled storage might be the reason for the extension of the shelf life. Taken together, CH incorporated with OEO or CEO could be developed as prospective edible packaging materials to preserve roast duck meat.

Factors Associated with Malignancy in Patients with Maximal Thyroid Nodules ≥2 Cm.

PURPOSE: The relationship between large thyroid nodules and the risk of malignancy is controversial. This study aimed to examine the relationship between thyroid nodule size and the risk of malignancy of maximal thyroid nodules ≥2 cm and the risk of accompanied by occult thyroid carcinoma. METHODS: This was a retrospective study of patients who underwent near-total or total thyroidectomy for thyroid nodules from January 2016 to January 2019 at the First Affiliated Hospital,Zhejiang University School of Medicine. Clinical, biochemical, and pathological characteristics were examined for association with malignancy using univariable, multivariable, and receiver operating characteristic curve analyses. RESULTS: Finally, 367 patients (277 females (75.5%) and 90 males (24.5%)) with a mean age of 49.0±13.5 years were included. Multivariable logistic regression analysis showed that age (OR=0.959, 95% CI: 0.939-0.979, P<0.001), Hashimoto's thyroiditis (OR=2.437, 95% CI: 1.162-5.112, P=0.018), the diameter of maximal nodule (small) (OR=0.706, 95% CI: 0.541-0.919, P=0.010), and punctate echogenic foci (OR=2.837, 95% CI: 1.598-5.286, P<0.001) were independently associated with malignancy. Of 223 patients who had non-suspicious malignant nodules (TI-RADS <4), 12.7% (n=29) patients showed malignancy at postoperative pathology. Only age was associated with occult PTC in the univariable analyses (OR=0.962, 95% CI: 0.934-0.991, P=0.011). When TPOAb was used as a continuous variable for statistical analysis, it showed a significant difference in the ROC curve, and the results showed TPOAb >31.4 mIU/L was more associated with occult PTC (P=0.006). A predictive model including four independent risk factors of malignancy showed an optimal discriminatory accuracy (area under the curve, AUC) of 0.783 (95% CI=0.732-0.833). CONCLUSION: Relatively young age (<54.5 years), Hashimoto's thyroiditis, the diameter of the maximal nodule, and punctate echogenic foci were independently associated with thyroid malignancy in patients with maximal thyroid nodules ≥2 cm. Young age (<54.5 years) and TPOAb >31.4 mIU/L were associated with occult PTC.

The steps and key points of thyroid surgery with lateral cervical incision.

The thyroid surgery with lateral cervical incision uses the sternocleidomastoid intermuscular approach through the gap between band muscles and carotid sheath to reach the surgical field. The recurrent laryngeal nerve and upper and lower parathyroid glands are first identified, the upper pole vessels are severed; then the Berry ligament is separated; the isthmus is severed, and the thyroid gland is finally removed. This approach can avoid the trauma of the skin and muscle tissue in the anterior neck region, to relieve the pressure on the neck and swallowing stretch feeling for patients after surgery. The surgical modality is effective and less time-consuming. This article gives a detailed introduction to the standardized procedures and some key points of thyroid surgery with lateral cervical incision.

Robot-Assisted Laparoscopic Excision of Complicated Retroperitoneal Tumors with Four Arms Via Retroperitoneal Way: A Unique Minimal-Invasive Approach.

Background: Surgical management of complicated retroperitoneal mass is one of the most challenging urologic oncologic surgeries. This study aims to describe our technique and experience in dealing with retroperitoneal mass. Methods: Three patients with complicated retroperitoneal mass were treated with robot-assisted surgery with four arms through retroperitoneal approach. Surgical Procedure: Our standardized anatomic-based "kidney safe first, then mass resection" technique for robot-assisted complicated retroperitoneal mass resection focused on minimizing the chance of renal pedicle injury. Baseline demographics, pathology data, and latest follow-up outcome were obtained. Results: In this retrospectively reviewed case series, all 3 patients were successfully treated with robot-assisted surgery with four arms during retroperitoneal space. One patient received paravertebral mass resection 2 weeks after the robotic surgery. Mean data included operative time of 175 minutes, estimated blood loss was 133 mL, and hospital stay was 4 days. No complications occurred. Conclusions: Robot-assist surgery for complicated retroperitoneal mass with four arms is a safe and feasible way. Patient Summary: Mini-invasive treatment for retroperitoneal mass with robotic four arms through retroperitoneal approach is a feasible way. The approach reduces interruption of intracorporeal structure and organs. And patients could benefit from the retroperitoneal approach with a quicker recovery.

Superior alignment but no difference in clinical outcome after minimally invasive computer-assisted unicompartmental knee arthroplasty (MICA-UKA).

PURPOSE: Variety of clinical trials have been published comparing the alignment of MICA-UKA with MI-UKA. However, to the best of our knowledge, no published study has showed whether radiological alignment by MICA-UKA has influence on the clinical results. The present study was conducted to compare the short-term results of MICA-UKA with MI-UKA. It was hypothesized that better alignment as well as clinical results was achieved by MICA-UKA as compared to MI-UKA. METHODS: The clinical and radiological results of 87 subjects who underwent primary UKA using either minimally invasive and computer-assisted technique (45 patients Group A) or minimally invasive technique (42 patients, Group B) were reported. Knee Society scores (KSSs), Knee Society functional scores (KSFSs), range of motion (ROM), and radiographic results were assessed and reported preoperatively and at 24-month follow-up. Total blood loss, operative time, and length of skin incision were compared. RESULTS: The accuracy of the implantations in relation to the coronal mechanical axis in Group A was significantly superior to that of Group B (P = 0.033). The femoral rotational profile revealed the prosthesis in Group A that was implanted with significantly less internal rotation than Group B (P = 0.025). Clinical results, with regard to ROMs and KSSs, as well as KSFSs were equally good in both the groups. The average blood loss in patients of Group A was significantly reduced as compared to patients of Group B. No significant difference was detected in terms of operative time or length of skin incision. CONCLUSIONS: It is suggested that MICA-UKA improves the implant alignment without increasing clinical results versus MI-UKA. We advocate that computer navigation should be considered when minimally invasive unicompartmental knee arthroplasty is performed. LEVEL OF EVIDENCE: Therapeutic study, Level II.

Arthroscopic single-bundle versus triple-bundle anterior cruciate ligament reconstruction.

OBJECTIVE: The aim of this prospective, randomized study was to compare the clinical results of arthroscopic single-bundle (SB) and triple-bundle (TB) anterior cruciate ligament (ACL) reconstruction. METHODS: The study included 105 patients who underwent arthroscopic SB ACL and TB ACL reconstruction. Anterior stress radiographs and the maximal manual muscle test using a KT-2000 arthrometer were used to assess anteroposterior stability and rotational stability was investigated using the lateral pivot shift test at the 24th month follow-up. Clinical results were assessed using the International Knee Documentation Committee (IKDC) and Orthopädische Arbeitsgruppe Knie (OAK) scores preoperatively and at the 24th month follow-up. Postoperative thigh circumference, strength and range of motion (ROM) were compared between groups. RESULTS: Rotational stability was significantly superior in the TB group than in the SB group. There were no statistically significant differences with regard to residual anteroposterior laxity determined at the 24th month follow-up. No significant difference in terms of IKDC score, OAK score, thigh circumference, strength and ROM was detected between the two groups. CONCLUSION: Both arthroscopic SB and TB ACL reconstruction resulted in satisfactory subjective outcome and objective stability. Rotational stability was significantly superior in the TB group.

Midterm outcomes of total cervical total disc replacement with Bryan prosthesis.

Short-term results have indicated that the Bryan cervical total disc replacement (TDR) favorably compares to anterior cervical decompression and fusion, while it is associated with fewer complications and higher levels of satisfaction. The aim of the present work was to assess the safety and efficacy of the device in the treatment for cervical degenerative disc disease, at 6-year follow-up. Fifty-eighty patients have performed their 6-year follow-up visit and have been analyzed clinically and radiologically. Clinical evaluation was based on neck disability index (NDI), visual analog scale (VAS), SF-36, and range of motion (ROM) at index levels. Each measurement was taken preoperatively and at 3 months, 6 months, 1 year, 3 years, and 6 years postoperatively. Complications and re-operations were also investigated. Occurrences of heterotopic ossifications (HO) and of adjacent level degeneration were detected by radiographs at 6-year follow-up. The mean NDI and VAS scores for arm and neck were significantly reduced for all postoperative periods compared with the average preoperative values. Motion was preserved at index levels (mean ROM = 8.6° ± 0.2° at 6 years), and 81.3 % of the segments were mobile at 6 years. HO was evident in 12/64 operated segments and not restricting the movement of the prosthesis in any case at 6-year follow-up. Six of sixty-four upper adjacent levels and 4/64 lower adjacent levels showed a slight degradation. There was 2 case of posterior migration of the prosthesis, which did not cause any clinical symptoms. No case showed evidence of subsidence, wear of the implant. At a 6-year follow-up, the cervical TDR using Bryan prosthesis displayed satisfactory clinical and radiographic outcomes without any significant complication. However, future efforts need to be directed toward the evaluation of a larger number of patients with longer follow-up.

Minimal invasive and computer-assisted total knee replacement compared with the minimal invasive technique: a prospective, randomized trial with short-term outcomes.

INTRODUCTION: Up to now, no prospective, randomized comparisons between minimal invasive and computer-assisted total knee arthroplasty (MICA-TKA), and minimal invasive technique (MI-TKA) has been documented to evaluate not only clinical, but also radiologic results of the MICA-TKA. This prospective, randomized study was performed to compare the short-term results of MICA-TKA with minimal invasive technique MI-TKA for 6-month follow-up. PATIENTS AND METHODS: We reported the clinical and radiological results of 80 subjects who had cruciate-substituting, TKA-implanted primary total knee arthroplasties using either minimal invasive and computer-assisted technique (40 patients Group I) or minimal invasive technique (40 patients, Group II). Tourniquet time, length of skin incision, and total blood loss were compared. Knee society scores (KSSs), knee society functional scores (KSFSs), range of motion (ROM), and radiographic results were assessed and reported preoperatively and at 6-month follow-up. RESULTS: The accuracy of the implantations in relation to the coronal mechanical axis in Group I was superior to that of Group II (P < 0.05). The femoral rotational profile revealed the prosthesis in Group I that was implanted with significantly less internal rotation than in Group II. The average blood loss in patients of Group I was significantly reduced as compared to patients of Group II. No significant difference was detected in terms of tourniquet time or length of skin incision. Clinical results, with regard to ROMs and KSSs, as well as KSFSs were equally good in both the groups. CONCLUSIONS: Better alignment and similarity of good clinical results at short-term follow-up may provide subjects who receive MICA-TKA with long-term endurance of their implants. Further studies on longer-term outcomes and functional improvements are required to validate these possibilities.

Efficacy of celecoxib for pain management after arthroscopic surgery of hip: a prospective randomized placebo-controlled study.

The present work was conducted to examine whether celecoxib, a selective COX-2 inhibitor, 200 mg administered 1 h preoperatively to patients undergoing arthroscopic hip surgery reduces postoperative pain. Fifty-three patients undergoing arthroscopic hip surgery under spinal anesthesia were randomized to receive either 200 mg of celecoxib (Group I) or 200 mg of placebo (Group II) 1 h preoperatively. Narcotic use was monitored for 24 h, and time in recovery room was determined. Visual analog scale (VAS) scores and Short-Form 12 (SF-12), including a physical composite score (PCS) and a mental composite score (MCS), documented pain in recovery, 12 h postoperatively, and 24 h postoperatively. Moreover, time in recovery room was also investigated. We enrolled 27 patients in Group I and 26 patients in Group II. Groups were comparable for patient characteristics. No significant difference was detected in terms of VAS scores and SF-12 in recovery room. Statistically, patients in Group I showed significantly lower pain VAS scores at 12 and 24 h postoperatively. Patients taking celecoxib had significantly higher PCS at 12 and 24 h postoperatively. No difference occurred between groups for the MCS. Patients taking celecoxib also showed a significant reduction in postoperative narcotic consumption. The obtained results from the current study indicate that patients who took celecoxib 200 mg 1 h before arthroscopic hip surgery had a less painful and more rapid recovery. Celecoxib 200 mg as a single preoperative dose could be considered as part of a perioperative analgesic plan in arthroscopic hip surgery.

Double-bundle versus single-bundle anterior cruciate ligament reconstructions: a prospective, randomized study with 2-year follow-up.

This prospective, randomized study was conducted to compare the short-term results of arthroscopic double-bundle with single-bundle anterior cruciate ligament (ACL) reconstruction. One hundred and eight patients with a symptomatic ACL rupture were randomized to either double-bundle (Group DB) or single-bundle (Group SB) ACL reconstruction. Follow-up was conducted at 6, 12, 18 and 24 months postoperatively. At the 24-month follow-up, 94 of the 108 patients (87%) were available for evaluation. The rotational stability, as evaluated by pivot shift test, was significantly superior in the Group DB to that in the Group SB. No significant difference with regard to ACL revisions, total flexion work, mean peak flexion torque and extension work between the groups was detected. There was no significant difference between the groups in terms of the Tegner activity score, the knee injury and osteoarthritis outcome score, the Lysholm functional score, anterior knee pain or mobility, subjective knee function. In addition, no significant difference in laxity on the Lachman test or the KT-1000 maximum manual force test was investigated. All the results were significantly more satisfactory at each follow-up period than preoperatively, in both groups. Both SB- and DB-ACL reconstruction resulted in satisfactory subjective outcome and objective stability. Both these techniques can therefore be considered as suitable alternatives for ACL reconstruction. Moreover, as it seems to be according to the pivot shift test, the risk for the development of degenerative changes of the knee joint in a long run could be smaller in the Group DB.

Arthroscopic versus mini-open rotator cuff repair: a prospective, randomized study with 24-month follow-up.

This prospective, randomized study was performed to evaluate the results of mini-open and arthroscopic rotator cuff repair in a comparative case series of patients followed for 24 months. A total of 125 patients were randomized to mini-open (Group I) or arthroscopic (Group II) rotator cuff repair at the time of surgical intervention. The University of California Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) index, and muscle strength were measured to evaluate the clinical results, while magnetic resonance arthrography was used at 24-month follow-up to investigate the postoperative rotator cuff integrity. Fifty-three patients in Group I and 55 patients in Group II were available for evaluation at 24-month follow-up. At 24-month follow-up, the UCLA score, the ASES index, and muscle strength were statistically significantly increased in both groups postoperatively, while no significant difference was detected between the 2 groups. Intact rotator cuffs were investigated in 42 patients in Group I and 35 in Group II, and there was a significant difference in postoperative structural integrity between the two groups (P < 0.05). When analysis was limited to the patients with full-thickness tear, the muscle strength of the shoulder was significantly better in Group II, and the retearing rate was significantly higher in Group II. Based on the results obtained from this study, it can be indicated that arthroscopic and mini-open rotator cuff repair displayed substantially equal outcomes, except for higher retearing rate in the arthroscopic repair group. While for patients with full-thickness tear, arthroscopic rotator cuff repair displayed better shoulder strength and significantly higher retearing rate as compared to mini-open rotator cuff repair at 24-month follow-up.

Minimally invasive and computer-assisted total knee arthroplasty versus conventional technique: a prospective, randomized study.

We conducted a prospective, randomized study to compare the short-term results of minimally invasive and computer-assisted total knee arthroplasty (MICA-TKA) with those of conventional total knee arthroplasty (C-TKA) for 12-month follow-up. A total of 87 subjects who met the inclusion and exclusion criteria of the study were prospectively randomized consecutively into two groups: the C-TKA group (Group A, n = 44) and the MICA-TKA technique (Group B, n = 43). All the operations were performed by the same senior surgeon. Before surgery and at follow-up, patients were evaluated by the same observer. Tourniquet time as well as total blood loss was compared. Knee Society scores (KSSs), Knee Society functional scores (KSFSs), range of motion (ROM), and radiographic results were assessed and reported preoperatively and at 12-month follow-up. Of these patients, 82 (Group A 42; Group B 40) were available for 12-month evaluation. The two groups were found to be similar in terms of coronal mechanical axis. Similarly, the femoral rotational profile revealed that the prosthesis in Group A was implanted with similar internal rotation to Group B. The average blood loss in patients of Group B was significantly reduced as compared to patients of Group A. No significant difference was detected in terms of tourniquet time. Clinical results in Group B, with regard to ROMs and KSSs, as well as KSFSs were significantly superior to that in Group A. Based on the results obtained from this study, it is demonstrated that MICA-TKA leads to a similarly accurate restoration of leg alignment and component orientation compared to the C-TKA. Moreover, MICA-TKA produces superior clinical results to that of C-TKA. However, there is clearly a need for additional high-quality clinical trials with long-term follow-up to confirm the clinical benefits of MICA-TKA.