Native nephrectomies in patients with autosomal dominant polycystic kidney disease: retrospective cohort study.

BACKGROUND: Approximately 1 in 5 patients with autosomal dominant polycystic kidney disease (ADPKD) will undergo a native nephrectomy in their lifetime. These can be emergent or planned and the indications can range from space for kidney transplant, pain, hematuria and frequent urinary tract infections (UTIs). Due to the diverse nature of presentations, there is a lack of certainty about outcomes and optimal management. AIMS: This study aimed to evaluate preoperative indications and perioperative/postoperative complications in this patient cohort. METHODS: This retrospective review included 41 patients with ADPKD who underwent unilateral or bilateral nephrectomy in a single hospital between 2010 and 2020. We collected data on patient demographics, surgical indications, histological results and postoperative complications. We sourced this information using the hospital's patient medical records. RESULTS: The main indications for nephrectomy were pain (39.5%) and bleeding (41.8%). Further indications included recurrent UTIs (16.3%), space for transplantation (27.9%), query malignancy (4.7%) and compressive gastropathy (2.3%). With regard to side, 55.8% were right-sided, 23.3% were left-sided, and 20.9% were bilateral. Seven percent of nephrectomy specimens demonstrated malignancy. Postoperative morbidity included requiring blood transfusion and long hospital stay. Thirty-seven percent of patients received a postoperative blood transfusion. There was no immediate or postoperative mortality associated with any of the cases reviewed. CONCLUSIONS: In conclusion, this study demonstrates that native nephrectomy remains a safe operation for patients with ADPKD. Although further research is needed into, transfusion protocols, adjunctive therapies, such as TAE and research into timing of nephrectomy are still needed.

A bibliometric analysis of the top 50 cited studies related to acromioclavicular joint instability.

Background: Acromioclavicular joint (ACJ) injury is a common orthopaedic condition accounting for over 40 % of all shoulder injuries. The purpose of this study is to assess the research trends and characteristics of the top 50 cited articles on ACJ instability. Methods: A systematic search was conducted in Web of Science to identify articles primarily related to ACJ injury or instability. Characteristics including citation number, country of origin, journal and institution of publication, impact factor, authorship, level of evidence, patient demographics, and study type were analyzed and recorded. Results: Research output on ACJ instability has been steadily increasing, with the top 50 cited studies predominantly presenting Level IV evidence. These studies primarily focused on treatment outcomes which included predominantly male patients and exhibited a large variation in citation counts. The American Journal of Sports Medicine was the most productive journal, and the USA was the most productive nation. Conclusion: There is an increasing number of publications in the ACJ instability literature, primarily concentrated in a few institutions and journals, and focusing mainly on treatment outcomes. A significant portion of these publications are of low scientific quality, and there is a notable lack of research on outcomes for females.

A bibliometric analysis of HER2-positive breast cancer: 1987-2024.

Aim: The overamplification of human epidermal growth factor (HER2) in breast cancer (BC) has been the subject of numerous research publications since its discovery in 1987. This is the first bibliometric analysis (BA) conducted on HER2-positive (HER2+) BC. The purpose of this BA is to analyze the published research on HER2+ BC from 1987 to 2024, highlighting the most significant scientific literature, as well as the main contributing authors and journals, and evaluating the impact of clinical and lab-based publications on HER2+ BC research. Methods: The Web of Science Core Collection (WoSCC) was searched using the terms "Breast cancer" OR "Breast carcinoma" OR "Breast tumor" AND "HER2 positive" OR "HER2+". The search was limited by publication year (1987-2024) and only full English articles were included. WoS returned 7,469 relevant results, and from this dataset, a bibliometric analysis was conducted using the "analyze results" and "journal citation report" functions in WoS and the VOSviewer 1.6.16 software to generate bibliographic coupling and co-citation analysis of authors. Results: The analysis encompassed a total of 7,469 publications, revealing a notable increase in the annual number of publications, particularly in recent years. The United States, China, Italy, Germany, and Spain were the top five most prolific countries. The top five significant institutions that published HER2+ research were the University of Texas System, Unicancer, UTMD Anderson Cancer Center, Harvard University, and University of California System. Breast Cancer Research and Treatment, Clinical Cancer Research, and Clinical Breast Cancer were the top three notable journals with the highest number of HER2+ BC publications. Dennis Slamon (Nc = 45,411, H-index = 51) and Jose Baselga (Nc = 32,592, H-index = 55) were the most prolific authors. Evolving research topics include anti-HER2 therapy in the neoadjuvant setting, treatment of metastatic HER2+ BC, and overcoming therapy resistance. Conclusion: This study provides an overview of HER2+ BC research published over the past three decades. It provides insight into the most cited papers and authors, and the core journals, and identifies new trends. These manuscripts have had the highest impact in the field and reflect the continued evolution of HER2 as a therapeutic target in BC.

Long-term outcomes of anterior shoulder instability treated with open latarjet procedure - a systematic review of outcomes at a minimum 15-year follow-up.

Background: To systematically review the literature to evaluate the outcomes following an open Latarjet (OL) procedure at a minimum 15-year follow-up. Methods: Two independent reviewers performed a literature search using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using 3 databases. Only studies reporting outcomes of OL procedure with a minimum of 15 years of follow-up were included. Results: Nine studies composed of 326 shoulders (78.2% males) in 313 patients were included (average age 26.9 ± 3.2 years (15-58)), with a mean follow-up of 271.9 ± 69.2 months (180-420) At a minimum 15-year follow-up, 93.5% (286 of 306) patients reported being satisfied with their OL procedure, whilst 86.8% (177 of 204) reported good/excellent outcomes at final follow-up. All nine of the included studies reported an overall rate of recurrent instability was 7.7%, with re-dislocations and subluxation at 3.4% and 5.8%, respectively. The rate of surgical revision was 5.15%; 3.5% of cases were revised for recurrent instability. Instability arthropathy was reported across all included studies as 41.0%. Conclusion: The OL procedure results in satisfactory clinical outcomes, low rates of recurrent instability and surgical revision at a minimum 15-year follow-up. Although high levels of radiological instability arthropathy and residual pain are found over the same period, these appear stable from a minimum of 10-year follow-up data. Level of Evidence: IV; a systematic review of all levels of evidence.

Return to Play After Surgical Treatment for Acromioclavicular Joint Dislocation: A Systematic Review.

BACKGROUND: Acromioclavicular (AC) joint dislocation is a common clinical problem among young and athletic populations. Surgical management is widely used for high-grade dislocations (Rockwood III-VI) and in high-demand athletes at high risk of recurrence. PURPOSE: To systematically review the evidence in the literature to ascertain the rate and timing of return to play (RTP) and the availability of specific criteria for safe RTP after surgical treatment for AC joint dislocation. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted in the PubMed database. Clinical studies were eligible for inclusion if they reported on RTP after surgical treatment for AC joint dislocation. Statistical analysis was performed with SPSS. RESULTS: We found 120 studies including 4327 cases meeting our inclusion criteria. The majority of patients were male (80.2%), with a mean age of 37.2 years (range, 15-85) and a mean follow-up of 34.5 months. Most were recreational athletes (79%), and the most common sport was cycling. The overall rate of RTP was 91.5%, with 85.6% returning to the same level of play. Among collision athletes, the rate of RTP was 97.3%, with 97.2% returning to the same level of play. In overhead athletes, the rate of RTP was 97.1%, with 79.2% returning to the same level of play. The mean time to RTP was 5.7 months (range, 1.5-15). Specific RTP criteria were reported in the majority of the studies (83.3%); time to return to play was the most commonly reported item (83.3%). Type III Rockwood injuries had the highest RTP rate at 98.7% and the earliest RTP at 4.9 months. Among the different surgical techniques, Kirschner wire fixation had the highest rate of RTP at 98.5%, while isolated graft reconstruction had the earliest RTP at 3.6 months. CONCLUSION: The overall rate of RTP was reportedly high after surgical treatment for AC joint dislocation, with the majority of patients returning to their preinjury levels of sport. There is a lack of consensus in the literature for what constitutes a safe RTP, with further focus on this topic required in future studies.

Young Collision Athletes Have High Rate of Return to Play and Good Clinical Outcomes Following Open Latarjet Procedure.

PURPOSE: To evaluate return to play (RTP), clinical outcomes, and recurrence rates in collision athletes 20 years of age and younger who underwent open Latarjet for anterior shoulder instability. METHODS: A retrospective review of collision athletes 20 years of age and younger, who underwent an open Latarjet procedure by a single surgeon between the years of 2010-2020 was carried out. Inclusion criteria were 1) collision athlete, 2) underwent open Latarjet procedure, 3) 16-20 years old, and 4) minimum 24-month follow-up. Exclusion criteria were 1) other pathology of the ipsilateral shoulder and 2) noncollision athlete. Rate of RTP, time to RTP, rate of return to preinjury level, the Shoulder Instability Return to Sport after Injury score (SIRSI) score, Subjective Shoulder Value (SSV), visual analogue scale (VAS) scores, and recurrence events were recorded. Quantitative statistical analysis was carried out. RESULTS: The study included 105 male collision athletes with a mean age of 18.6 ± 1.0 years (range: 17-20). The mean follow-up for patients was 36 ± 26.2 months. A total of 93 (88.6%) RTP at a mean time of 6.3 ± 2.2 months, with 73 (69.5%) returning to their preinjury level of participation. The mean SIRSI score was 69.2 ± 21.8, the mean VAS score was 2.3 ± 2.1, and the mean SSV score was 84.1 ± 16.8. Five patients (4.8%) redislocated their shoulder, with 4 of these requiring a further surgery (3.8%). Two patients (1.9%) reported incidents of subluxation. CONCLUSIONS: The open Latarjet procedure in young collision athletes results in high rates of RTP, excellent functional outcomes and low recurrence rates at mid-term follow-up. Additionally, complication rates are low in this cohort. LEVEL OF EVIDENCE: Level IV, case series.

Posterior Shoulder Instability but Not Anterior Shoulder Instability Is Related to Glenoid Version.

Purpose: To assess and compare glenoid version in patients with anterior shoulder instability (ASI), posterior shoulder instability (PSI), and a control group. Methods: The operative notes of all patients that had undergone arthroscopic shoulder instability repair between January 2017 and May 2022 were retrospectively reviewed. Magnetic resonance imaging scans were then analyzed, and glenoid version was measured by a single blinded observer. A P value <.05 was considered statistically significant. Results: There were 100 patients included in the ASI group, 65 in PSI group, and 100 in the control group. The mean glenoid versions for the ASI group were -16°, -9.1°, and -9.2° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean glenoid versions for the PSI group were -21°, -13.4°, and -16.6° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean versions for the control group were -17.8°, -9.5°, and -9.8° for the vault version, simplified vault version and chondrolabral version, respectively. ANOVA testing and post hoc comparisons revealed the PSI group to be significantly more retroverted than both other groups P < .001. The ASI group's degree of glenoid version was not significantly different to that of the control P = .009. Conclusion: Patients with PSI have a higher degree of retroversion in comparison to those with ASI and control. There is no significant difference in glenoid version among patients with ASI when compared with control. Level of Evidence: Level III, retrospective comparative study.

Return to play in paediatric & adolescent patients following anterior cruciate ligament reconstruction.

BACKGROUND: There is an increased risk of anterior cruciate ligament (ACL) rupture and subsequent ACL reconstruction in patients <18 years old due to their high levels of sporting participation. PURPOSE: The purpose of this study was to assess the rate and timing of return to play (RTP) in paediatric and adolescent patients following ACL reconstruction, and to compare the outcomes between those undergoing ACL reconstruction with bone patella tendon bone autograft (BTB) and hamstring tendon (HT) autograft. STUDY DESIGN: Level of Evidence: Level III; Retrospective Comparative Cohort Study. METHODS: The institutional ACL registry was screened for patients <18 that had undergone a primary ACL reconstruction. Outcomes were analysed for patients undergoing either a BTB or HT autograft for rate and timing of return to play, functional outcomes and subsequent knee injuries. Statistical analysis was performed using SPSS. RESULTS: 358 (BTB; 253, HT; 105) patients were followed up for 24-months (95% follow up). 86 athletes (27 BTB; 59 HT) were aged 13-15 years old with no significant difference in RTP rate or timing between graft types, however, there was a difference in ipsilateral re-ruptures (10.2% HT vs 0% BTB p = 0.03). 272 athletes (226 BTB; 46 HT) were aged 16-18 years old with no significant difference in RTP rate or timing between graft types, or ipsilateral re-ruptures (8.7% HT vs 2.7% BTB p = 0.07). Concurrent ligament, meniscal or chondral injuries found at the time was treated as necessary. CONCLUSION: Paediatric and adolescent patients undergoing ACL reconstruction with either BTB or HT had high rates of return to play. This was seen in both subgroups with 13-15-year-olds mostly receiving a HT graft repair and 16-18-year-olds mainly receiving a BTB repair. A moderate re-rupture rate was seen at 24-months. However longer follow up is needed to truly see the long-term impact of such an injury at such a young age.

Type V superior labral anterior-posterior tears results in lower rates of return to play.

PURPOSE: The purpose of this study was to evaluate the rate of return to play (RTP) in patients who underwent Type V superior labrum anterior-posterior (SLAP) repair compared to patients who underwent isolated Bankart repair in the setting of traumatic anterior shoulder instability. METHODS: A retrospective review of patients who underwent arthroscopic Bankart repair and SLAP repair by a single surgeon between 2012 and 2017 was performed. Additionally, these were pair-matched in a 1:2 ratio for age, sex, sport and level of pre-operative play, with those undergoing isolated arthroscopic Bankart repair alone as a control group. RTP, level of RTP and the timing of RTP were assessed. RESULTS: The study included a total of 96 patients, with 32 in the study group and 64 in the control group, and a mean follow-up of 59 months. Overall, there was no significant difference in the overall rate of return to play (26/32 (81.3%) vs 56/64 (87.5%), n.s), but there was a significantly higher rate of RTP at the same/higher level in the control group (14/32 (43.6%) vs 43/64 (67.2%), p = 0.0463). There was no significant difference in timing of RTP between the groups (n.s). There was no significant difference in recurrent instability (6/32 (18.8%) vs 5/64 (7.8%), n.s) but there was a significant difference in revision rates (5/32 (15.6%) vs. 2/64 (3.1%), p = 0.0392) between the Type V SLAP repair group and the control group. CONCLUSION: Following arthroscopic repair, patients with Type V SLAP tears had a similar overall rate of RTP when compared directly to a control group of patients who underwent arthroscopic Bankart repair alone. However, those who underwent Type V SLAP repair reported significantly lower rates of RTP at the same or higher level compared to the control group. LEVEL OF EVIDENCE: III.

Outcomes following arthroscopic Bankart repair in female patients.

PURPOSE: The purpose of this study is to evaluate clinical outcomes and recurrence among women who have undergone an arthroscopic Bankart repair for recurrent anterior shoulder instability. METHODS: A retrospective review of patients with anterior shoulder instability that have undergone an arthroscopic Bankart repair between 2012-2017 was performed. Patients were followed up to assess their visual analog scale (VAS) score, Rowe score, Shoulder Instability-Return to Sport after Injury (SIRSI), and the Subjective Shoulder Value (SSV) and their satisfaction level. Whether they were able to return to sport, the timing of return, and the level to which they returned were reported. RESULTS: Our study included 31 female patients (34 shoulders), with a mean follow-up of 51.9 months. Overall, 82.4% (28/34 shoulders) were satisfied/very satisfied with their surgery. The mean scores were as follows: Rowe, 79.2; SIRSI, 53.9; SSV, 81.9; and VAS, 1.9. Of the 29 patients (32 shoulders) who played sport prior to surgery, 24 returned to play and 17 returned to the same or higher level. One patient suffered a recurrent dislocation and 2 patients suffered recurrent subluxation. No patients underwent a revision procedure. CONCLUSION: Female patients with anterior shoulder instability treated with arthroscopic Bankart repair have low recurrence rates, with good patient-reported outcomes and high satisfaction rates. Of those participating in sport prior to surgery, there was a high rate of return to play. The overall rate of complications was low, with a low rate of revision surgery.