[Emphasizing the timing and procedure selection for vitrectomy in pathological myopic traction maculopathy].

Myopic maculopathy is the primary cause of irreversible visual impairment in patients with pathologic myopia, and myopic traction maculopathy often requires vitrectomy for treatment. Myopic traction maculopathy encompasses epiretinal membrane, foveoschisis, macular hole, and macular hole-related retinal detachment. It is recommended to perform vitrectomy combined with inner limiting membrane peeling for Type II epiretinal membrane, foveal-sparing inner limiting membrane peeling for foveoschisis, inverted inner limiting membrane flap technique for macular hole, and vitrectomy combined with macular buckle for refractory macular hole-related retinal detachment. Myopic traction maculopathy is a chronically progressive condition, and surgeons need to accurately determine the timing of surgery and choose appropriate procedures to maximize the benefits for patients.

CLOSURE OF IDIOPATHIC FULL-THICKNESS MACULAR HOLE AFTER INTRAVITREAL C3F8 INJECTION WITHOUT VITREOMACULAR TRACTION RELEASE: A CASE REPORT AND REVIEW OF LITERATURE.

BACKGROUND: The purpose of this study was to describe a successful closure of macular hole without release of vitreomacular traction after intravitreal perfluoropropane (C3F8) gas injection. CASE PRESENTATION: A 54-year-old woman was referred to our clinic with the history of declined vision after a period of distorted vision in her right eye. After dilated fundus examination and performing optical coherence tomography, a V-shaped vitreomacular traction complicated by full-thickness macular hole was diagnosed and she underwent pneumatic vitreolysis using intravitreal C3F8 gas injection. After 12 weeks, her visual acuity was significantly improved and fundus examination and optical coherence tomography revealed that the macular hole was completely resolved despite persisted vitreomacular traction. CONCLUSION: Intravitreal gas injection would be a promising option to manage idiopathic macular holes not only by releasing the vitreous traction on the macula but also through some not proven or even unknown mechanisms.

Biomechanical study of the effect of traction on elbow joint capsule contracture.

Dynamic orthoses have a significant effect on the treatment of elbow capsular contracture. Because of the lack of quantitative research on traction forces, determining the appropriate traction force to help stretch soft tissues and maintain the joint's range of motion is a challenge in the rehabilitation process. We developed a human elbow finite element (FE) model incorporating the activity behavior of the muscles and considering different capsular contracture locations, including total, anterior and posterior capsular contractures, to analyze the internal biomechanical responses of different capsular contracture models during flexion (30 to 80 degrees). Traction loads of 10, 20, 30 and 40 N were applied to the ulna and radius at the maximum flexion angle (80 degrees) to explore the appropriate traction loads at week 4 after a joint capsule injury. We observed a significant increase in posterior capsule stress with anterior capsular contracture (ACC), and the maximum peak stress was 1.3 times higher than that in the healthy model. During the fourth week after elbow capsule injury, the appropriate traction forces for total capsule contracture (TCC), ACC and posterior capsule contracture (PCC) were 20, 10 and 20 N, respectively; these forces maintained a stable biomechanical environment for the elbow joint and achieved a soft tissue pulling effect, thus increasing elbow mobility. The results can be used as a quantitative guide for the rehabilitation physicians to determine the traction load for a specific patient.

Stripping of the Posterior Hyaloid for the Treatment of Vitreomacular Traction.

PURPOSE: To describe and evaluate the effectiveness of stripping the posterior hyaloid as vitreomacular traction treatment. METHODS: This prospective, consecutive, interventional study examined 10 eyes of 10 patients who underwent vitrectomy for vitreomacular traction. RESULTS: The best-corrected visual acuity improved from 20/63 (0.5 ± 0.18 logMAR) preoperatively to 20/36 (0.25 ± 0.15 logMAR) 3 months after the surgeries. Optical coherence tomography analysis showed a reduction of the mean foveal thickness from 462 ± 82 µ to 372 ± 28 µ at 3-month follow-up in all the eyes. No postoperative complications were reported. CONCLUSION: Stripping of the posterior hyaloid for the treatment of vitreomacular traction could improve the symptoms and visual acuity of patients, alleviating the traction on the macula and avoiding secondary retinal damage as macular hole formation.

Extraction of impacted mandibular third molars in close proximity to the inferior alveolar canal with coronectomy-miniscrew traction to avoid nerve injury.

OBJECTIVES: Extraction of impacted mandibular third molars (IMTMs) is the most common surgery performed in the Department of Oral and Maxillofacial Surgery. Inferior alveolar nerve (IAN) injury is a rare but severe complication, and the risk is significantly higher in cases of IMTM near the inferior alveolar canal (IAC). The existing surgical method to extract such IMTMs is either not safe enough or is time-consuming. A better surgical design is needed. MATERIALS AND METHODS: From August 2019 to June 2022, 23 patients underwent IMTM extraction by Dr. Zhao at Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, and were found to have IMTMs in close proximity to the IAC. Due to high IAN injury risk, these patients underwent coronectomy-miniscrew traction to extract their IMTMs. RESULTS: The time between coronectomy-miniscrew insertion and complete removal of the IMTM was 32.65 ± 2.110 days, which was significantly shorter than that of traditional orthodontic traction. Two-point discrimination testing revealed no IAN injury, and no injury was reported by patients during follow-up. Other complications, such as severe swelling, severe bleeding, dry socket, and limited mouth opening, were not observed. Postoperative pain levels were not significantly higher in the coronectomy-miniscrew traction group than in the traditional IMTM extraction group. CLINICAL RELEVANCE: For IMTMs that are in close proximity to the IAC and must be extracted, coronectomy-miniscrew traction is a novel approach to minimize the risk of IAN injury in a less time-consuming way with a lower possibility of complications.

Efficacy of Tracheal Traction Exercise for Prevention of Laryngopharyngeal Complications Following Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: Tracheal traction exercise (TTE) has been proposed as a preventative measure for laryngopharyngeal complications following anterior cervical discectomy and fusion. However, the exact effects of TTE remain controversial. Therefore, we conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy of TTE. METHODS: We systematically searched PubMed, Web of Science, Embase, Cochrane, ClinicalTrials.gov, China National Knowledge Infrastructure, WANFANG DATA, VIP citation databases, and Chinese BioMedical Literature Database for randomized controlled trials (published between January 1, 2000, and January 23, 2023, without language restrictions) comparing the TTE group to the control group (non-TTE group). We assessed the risk of bias using Cochrane risk of bias assessment tool. Our primary end points were operation duration, the number of patients with postoperative dysphagia, and Visual Analog Scale (VAS) for laryngopharyngeal pain. We used a fixed-effects model to assess the pooled data. RESULTS: Of the 823 identified studies, 5 were eligible and included in our analysis (N = 542 participants). Compared with the control group, TTE reduced the incidence of postoperative dysphagia (relative risk = 0.41, 95% confidence interval [CI]: 0.28, 0.61, P < 0.05) and operation duration (weighted mean difference = -10.24, 95% CI: -14.48, -6.00, P < 0.05). However, no significant difference was observed in postoperative VAS between the 2 groups (weighted mean difference = -0.11, 95% CI: -0.23, 0.11, P = 0.08 > 0.05). CONCLUSIONS: TTE can effectively reduce operation duration and postoperative dysphagia. However, it does not result in a significant difference in postoperative VAS.

The histopathologic diagnosis of traction alopecia: An evidence-based model.

BACKGROUND: Traction alopecia (TA) is common, but histopathologic criteria for TA have not been objectively defined. OBJECTIVE: Determine whether the pauci-follicular unit (PFU) can be used as a diagnostic criterion for TA. Compared to a normal follicular unit (NFU), the PFU is a noninflamed follicular unit with an intact sebaceous gland but fewer than 2 follicles. METHODS: A retrospective review of 25 cases of TA and 25 cases of "normal scalp" was performed. Data included all follicles (by size and phase), sebaceous glands, and total follicular units. RESULTS: Comparing data (traction vs normal), we found a significantly higher number of PFUs in cases of TA (median 6 vs 0, P < .001), which can be used as a helpful and easily recognizable diagnostic tool in diagnosing cases of TA. LIMITATIONS: Comparison to other forms of alopecia was not performed. CONCLUSIONS: The number of PFUs in an alopecia biopsy can be used to establish the diagnosis of TA.

Efficacy of Vitrectomy With Tamponade Versus No Tamponade for Myopic Traction Maculopathy: A Multicenter Study (SCHISIS Report No.1).

PURPOSE: To evaluate the influence of tamponade on the visual and anatomic outcomes of pars plana vitrectomy for myopic traction maculopathy (MTM). DESIGN: Multicenter, retrospective clinical cohort study. METHODS: Consecutive eyes that underwent vitrectomy for advanced MTM with tamponade of air, sulfur hexafluoride (SF6), or perfluoropropane (C3F8) or without tamponade with a minimum follow-up of 12 months were included. Main outcome measures included postoperative visual acuity (VA) at 12 months in eyes with vs without tamponade. RESULTS: We included a total of 193 eyes (193 patients) in this study; 136 eyes (70%) treated with tamponade were compared with 57 eyes (30%) treated without tamponade. Baseline characteristics did not differ significantly between the groups. Both groups showed significant visual improvement at 12 months (both P < .001). However, postoperative visual acuity and visual improvement at 12 months were significantly better (P = .003 and P = .028, respectively) in eyes without tamponade, although the MTM in these eyes without tamponade took longer to resolve (P = .039). Retinal thickness and the ellipsoid zone were more preserved in eyes without tamponade (P < .001 and P = .001, respectively). Complications such as macular holes did not differ between the groups. A novel imaging finding of "schisis bending (accordioning)" was identified during MTM resolution. CONCLUSIONS: Vitrectomy either with or without tamponade for MTM was effective in improving vision in this study. However, eyes without tamponade experienced even better visual improvement and preserved retinal anatomy, despite a longer schisis resolution time. Surgery without tamponade may achieve better visual outcomes.

Risk Factors and Outcomes of Postoperative Macular Hole Formation after Vitrectomy for Myopic Traction Maculopathy: SCHISIS Report No. 2.

PURPOSE: To evaluate the incidence, pathogenesis, risk factors, and treatment outcomes of postoperative macular hole (MH) after pars plana vitrectomy (PPV) for myopic traction maculopathy (MTM). DESIGN: Multicenter, interventional, retrospective case series. SUBJECTS: Consecutive eyes that underwent PPV for MTM with a minimum 6-month follow-up. METHODS: We investigated the characteristics and treatment outcomes of postoperative MH after MTM surgery. MAIN OUTCOME MEASURES: Incidence, risk factors, and anatomic and visual outcomes of postoperative MH. RESULTS: We included 207 eyes (207 patients) with a mean follow-up of 25.9 months. During follow-up, 24 (11.6%) eyes developed MH (10 with concurrent MH retinal detachment); 15 eyes within 30 days (early), 4 eyes between 31 and 180 days (intermediate), and 5 eyes after 180 days (late). Logistic regression analysis revealed male gender (odds ratio [OR], 2.917; 95% confidence interval [CI], 1.198-7.100; P = 0.018), thinner preoperative choroidal thickness (OR, 0.988; 95% CI, 0.976-1.000; P = 0.048), and use of indocyanine green for internal limiting membrane peeling (OR, 2.960; 95% CI, 1.172-7.476; P = 0.022) as significant risk factors for postoperative MH. Internal limiting membrane peeling with a fovea-sparing technique tended to protect against postoperative MH, but it was not statistically significant (P = 0.096), because 1 eye still developed MH. Postoperative MHs were treated by observation (6 eyes), in-office octafluoropropane (C3F8) gas injection (7 eyes), or PPV (11 eyes). Macular hole closure was achieved in 20 eyes (83%). The hole closure rate was 67% (4/6 eyes) after observation, 71% (5/7 eyes) after C3F8 gas injection, and 91% (10/11 eyes) after PPV. However, visual outcomes were significantly worse for eyes with postoperative MH than those without (0.38 ± 0.43 vs. 0.68 ± 0.46; P = 0.002). CONCLUSIONS: Postoperative MH may occur in 11.6% of patients with MTM at any time after surgery. Retreatment resulted in relatively favorable anatomic closure but unfavorable visual outcomes. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Traction alopecia: assessing the presentation, management and outcomes in a diverse urban population.

Traction alopecia (TA) is a type of hair loss caused by repetitive tension placed on the hair follicle. An institutional review board-approved retrospective study was conducted at a single institution located in the Bronx, New York. The review identified 216 unique patients with TA and collected information on demographics, patient presentation, history, physical exam, treatment, follow-up and disease improvement. Almost all patients identified as female (98.6%), and most were Black or African American (72.7%). Mean (SD) age was 41.3 (17.1) years (median 40 years; range 1-88). Patients reported hair loss for a mean duration of 35 (51.1) months (median 18 months; range 1-264) prior to presentation. Most patients experienced asymptomatic hair loss. Around half (49.1%) of the patients attended a follow-up, with 42.5% of these patients noting improvement in hair loss or symptoms across all visits. Duration of hair loss was not associated with improvement in hair loss at follow-up visit (P = 0.23).

Three-dimensional decision support system for treatment of canine impaction.

INTRODUCTION: This study aimed to develop a 3-dimensional (3D) characterization of the severity of maxillary impacted canines and to test the clinical performance of this characterization as a treatment decision support tool. METHODS: Cone-beam computed tomography images obtained from 83 patients with 120 impacted maxillary canines were included. Quantitative information on the canine 3D position and qualitative assessment of root damage of adjacent teeth were evaluated. A severity index was constructed on the basis of the quantitative findings. Clinical applicability was tested by comparing clinical diagnosis and treatment planning for conventional records vs the 3D characterization via a 2-part survey. RESULTS: The average quantitative assessments of impacted maxillary canine position were 6.4 ± 3.6 mm from the midsagittal plane, 11.6 ± 3.1 mm in height relative to the occlusal plane, 31.5° ± 18° of roll, and 48.8° ± 14.3° of pitch. The severity index ranged from 0-13 with a mean score of 4.5 ± 2.2. Overlap with adjacent teeth was the greatest contributor (33%) to the index. Bicortically impacted canines caused the most severe root damage. Cone-beam computed tomography was preferred for assessing root damage and overall severity, whereas conventional imaging was sufficient for height and angulation assessment. The 3D report was very important or important for evaluating root damage, canine position, overall severity, and overlap. The 3D report changed most of the decisions relating to biomechanics, patient education, and treatment time estimate. The decision of exposure and traction vs extraction was changed 22% of the time after the presentation of the 3D report. CONCLUSIONS: The overlap with adjacent teeth frequently contributes the most to the severity index. The 3D report provided relevant clinical information regarding the canine position, damage to adjacent teeth, and the severity index, with a profound impact on the decisions of the clinicians regarding biomechanics, patient education, and treatment time estimate.

Multimodel Imaging Evidence of Traction Component in Lamellar Macular Hole with Epiretinal Proliferation.

INTRODUCTION: The aim of this study was to investigate the association of epiretinal traction in idiopathic lamellar macular hole (LMH) with or without lamellar hole-associated epiretinal proliferation (LHEP). METHODS: A retrospective consecutive case series included 108 eyes diagnosed with LMH in a single tertiary referral center. Epiretinal traction was determined by the presence of epiretinal membrane (ERM), attached posterior hyaloid, or vascular traction with multimodal imaging studies and intraoperative findings in those received surgical interventions. RESULTS: The 53 LMHs with LHEP had similar age, refraction, initial, and final visual acuity to the 55 LMHs without LHEP. Both groups exhibited high incidences of vascular traction (with and without LHEP: 92% and 84%, p = 0.36, respectively) and ERM and/or attached posterior hyaloid (both 100%, p = 1.00). The vision improved 10.5 and 14 ETDRS letters (p = 0.60) in the 30 eyes with and 19 eyes without LHEP that underwent vitrectomy. Vascular tractions released postoperatively in 88% and 100% of LMHs with and without LHEP, respectively (p = 0.27). The LMH, ERM foveoschisis, and mixed subtypes exhibited epiretinal traction in 100% of cases in all subtypes (p = 1.00). CONCLUSION: Our findings indicated that epiretinal traction, evaluated by multimodal imaging, is the norm rather than the exception in LMHs showing LHEP. The presence of tractional forces should be taken into consideration when treatment was planned in LMHs.

Editorial Commentary: Minimizing Traction Force and Time as Well as Application of Specific Technical Pearls Might Trump the Importance of Choosing Between Post or Postless Hip Arthroscopy With Regards to Complications.

Recently, there has been a trend toward performing hip arthroscopy without a post (postless) in an effort to decrease perineal post-related complications. Previous studies have revealed a variable risk of pudendal nerve neuralgia and perineal soft-tissue injury when using a post. There is emerging evidence that arthroscopic hip procedures can be done without the use of a post, with less traction force on the perineal region, and with adequate exposure to safely accomplish a well-done femoroacetabular impingement corrective procedure. Prospective comparative studies with conclusive evidence of the superiority of either technique, however, are lacking. Complications with a post are likely associated with high traction forces, prolonged traction times, and potentially suboptimal technique and patient positioning. In addition, postless traction is in its infancy and new adverse events/outcomes are likely to emerge. There are likely specific situations and patient populations in which one technique might be superior to the other. We are the carpenters of medicine and rather than blaming our tools and throwing out a technique that has served us well for decades, we should better understand some important pearls and pitfalls that might allow either method to be safely performed.

The novel traction-suturing technique in correction of caudal end deviation of the nasal septum.

BACKGROUND: Caudal end correction is one of the main challenges during septoplasty that needs extra steps and skills. This complex area affects the shape of the nose. Moreover, the caudal end represents the medial boundary of the internal nasal valve. Thus, any deviation may disturb this critical area causing nasal obstruction. This study aimed to evaluate the novel traction-suture technique to correct septal caudal end deviation and its postoperative impact. STUDY DESIGN: This prospective case-series study. SETTINGS: It was held in a tertiary referral university institute between January 2019 to February 2022. METHODS: We included 95 cases who suffered from nasal obstruction and a cosmetic problem because of mild or moderate caudal end deviation. Under general anesthesia, the caudal end was corrected by the novel traction-suturing technique (TST). To evaluate the surgical outcomes and patients' related quality of life, we used two validated questionnaires; the Nasal Obstruction Symptom Evaluation and the Rhinoplasty Outcome Evaluation before the surgery and 1 year after the surgery. RESULTS: NOSE and ROE questionnaires showed statistically significant improvements after the surgery (P value was < 0.001). Complications occurred in seven patients (7.3%), all of which were minor complications. CONCLUSIONS: Traction-suturing technique (TST) improved nasal breathing and patients' satisfaction with their nasal configuration. Traction-suturing is a simple short maneuver that junior doctors can easily learn without distinct complications or recurrence.

Four-corners traction combined with continuous everting suture technique as a modification in bicaval anastomosis for orthotopic heart transplantation.

BACKGROUND: Although standard bicaval techniques has become popular in orthotopic heart transplantation, distortion, bleeding, thrombosis and arrhythmia were still causes for concern. This study was designed to compare the standard bicaval techniques and modified bicaval techniques in our institution. MATERIALS AND METHODS: A total of 70 recipients underwent orthotopic heart transplantation at our center from June 2015 to April 2019 (standard group = 24 cases, modified group = 46 cases). The average follow-up period was 46.4 ± 17.4 months. Atrioventricular cavity diameter was measured by ultrasonography and left atrial morphology was evaluated by CT-angiography and three-dimensional reconstruction. RESULTS: Recipients in both groups were similar with pre-operative characteristics. Total ischemic, cardiopulmonary bypass and cross-clamp times were similar. The modified bicaval techniques group has a significantly fewer blood transfusion, lower post-transplant tricuspid regurgitation grade and the incidence of post-operative atrial arrhythmia than standard bicaval techniques group. CT-angiography and three-dimensional reconstruction illustrated ideal and physiologic left atrial morphological structure. Short-term survival differed significantly and the cumulative proportion of survival was significantly higher in the modified bicaval techniques group than that in the standard bicaval techniques group. CONCLUSIONS: This study showed that modified bicaval techniques offers a better early outcome than standard bicaval techniques. The significant reduction of intraoperative blood transfusion and post-transplant tricuspid regurgitation grade in the modified bicaval techniques group may has a major impact on the short-term survival.

Mesenteric traction syndrome - Incidence, impact, and treatment: A systematic scoping review of the literature.

BACKGROUND: Mesenteric traction syndrome (MTS) is commonly seen during major abdominal surgery and is characterised by facial flushing, hypotension, and tachycardia 15 min into surgery. MTS also impacts the postoperative course, as severe MTS has been associated with increased postoperative morbidity. However, despite MTS being common and severe MTS causing increased postoperative morbidity, the gaps in the literature are not clearly defined. We aimed to examine the diagnostic criteria, incidence, intraoperative and postoperative impact, and potential preventative measures of MTS while highlighting potential gaps in the literature. METHODS: We followed the Prisma guidelines and performed a systematic literature search. We included only human studies examining MTS. All hits were screened for title and abstract, followed by a full-text review by at least two authors for determining eligibility for inclusion. Data were extracted and risk of bias was assessed by two independent reviewers. RESULTS: A total of 37 studies, comprising 1102 patients were included in the review. The combined incidence of MTS during open abdominal surgery was found to be 76%, with 35% developing severe MTS. It was found that the development of MTS was associated with marked haemodynamic changes. It was also found that several different subjective diagnostic criteria exist and that severe MTS was associated with increased postoperative morbidity. Furthermore, several preventative measures for protecting against MTS have been examined, but only on the incidence of MTS and not on the postoperative course. CONCLUSION: MTS occurs in 76% of patients undergoing major abdominal surgery and is associated with deleterious haemodynamic effects, which are more pronounced in patients developing severe MTS. Severe MTS is also associated with a worse postoperative outcome. However, gaps are still present in the current literature on MTS.

Comparison of Lateral versus Medial Entry Femoral Traction Pin Complication Rates.

Distal femoral skeletal traction is a common procedure for the stabilization of fractures of the pelvis, acetabulum, and femur following trauma. Femoral traction pins are traditionally inserted via medial-to-lateral (MTL) entry to accurately direct the pin away from the medial neurovascular bundle. Alternatively, cadaveric studies have demonstrated low risk to the neurovascular bundle using a lateral-to-medial (LTM) approach. The purpose of this study was to compare the incidence of complications of LTM and MTL femoral traction pin placement at a single institution. This was a retrospective review of patients from the orthopaedic consult registry at a academic Level I Trauma Center. We identified 233 LTM femoral traction pin procedures in 231 patients and 29 MTL pin procedures in 29 patients. The two pin placement techniques were compared with respect to complications, specifically the incidence of neurovascular injury, cellulitis, septic arthritis, osteomyelitis, and heterotopic ossification after femoral traction pin placement. Two complications were reported. One patient developed heterotopic ossification along the pin tract after LTM traction pin placement. Another patient developed septic arthritis after LTM pin placement, likely attributable to retrograde intramedullary nailing of his open femur fracture rather than his traction pin. There were no reports of neurovascular injury, cellulitis, or osteomyelitis associated with pin placement. The complication rate was 0.9% for LTM group and 0.0% for MTL group (p = 0.616). LTM femoral traction pin placement is a safe procedure with a similarly low complication rate compared with traditional MTL placement when the limb is positioned in neutral alignment. (Journal of Surgical Orthopaedic Advances 32(4):259-262, 2023).

Comparison Between Preincision Traction and On-Demand Traction in Assisting Colorectal Endoscopic Submucosal Dissection.

INTRODUCTION: Adequate exposure of the dissection site is very important for colorectal endoscopic submucosal dissection (ESD). We aimed to investigate the safety and efficacy of the preincision traction (PIT) method using an internal clip-with-spring device in comparison with the conventional on-demand traction (ODT) method in assisting colorectal ESD. METHODS: This was a prospective nested case-control study. A total of 26 patients for PIT-ESD and other 26 patients for ODT-ESD were involved. Data on clinical characteristics and therapeutic outcomes were collected and analyzed. RESULTS: The en bloc resection rate (both 100%) and curative resection rate (92.3% vs 96.2%) showed no significant difference between the 2 groups. Compared with ODT-ESD, PIT-ESD significantly reduced the procedure time (29.8 ± 18.4 vs 57.4 ± 33.7 minutes, P = 0.001) and submucosal injection volume (49.6 ± 32.3 vs 70.8 ± 37.6 mL, P = 0.034), decreased the rate of intraoperative bleeding (26.9% vs 57.7%, P = 0.025) and muscular injury (7.7% vs 34.6%, P = 0.038), and shortened the postoperative hospital stay (1.8 ± 0.8 vs 2.5 ± 1.2, P = 0.015). DISCUSSION: The PIT method could significantly improve the safety and efficacy of colorectal ESD.

Surgical Correction of Neuromuscular Scoliosis Secondary to Congenital Zika Syndrome: A Case Report.

CASE: Congenital Zika syndrome (CZS) has been noted after the South American pandemic of Zika virus which peaked in 2015 to 2016, and the associated sequelae are still being described. Scoliosis has been noted in patients with CZS; however, there is a paucity of literature on the prevalence or management of scoliosis secondary to this condition. We report the case of a 5-year-old girl with severe neuromuscular scoliosis due to CZS that was managed with halo-gravity traction, followed by a growth-friendly construct. CONCLUSION: This case report highlights the need for more research focusing on the survivors of the Zika pandemic.