Assessment of association between lower ureteric excision technique and oncological outcomes for upper urinary tract urothelial carcinoma: retrospective analysis from the Scottish Renal Cancer Consortium.

PURPOSE: Nephroureterectomy(NU) remains the gold-standard surgical option for the management of upper urinary tract urothelial carcinoma(UTUC). Controversy exists regarding the optimal excision technique of the lower ureter. We sought to compare post-UTUC bladder tumour recurrence across the Scottish Renal Cancer Consortium(SRCC). METHODS: Patients who underwent NU for UTUC across the SRCC 2012-2019 were identified. The impact of lower-end surgical technique along with T-stage, N-stage, tumour location and focality, positive surgical margin, pre-NU ureteroscopy, upper-end technique and adjuvant mitomycin C administration were assessed by Kaplan-Meier and Cox-regression. The primary outcome was intra-vesical recurrence-free survival (B-RFS). RESULTS: In 402 patients, the median follow-up was 29 months. The lower ureter was managed by open transvesical excision in 90 individuals, transurethral and laparoscopic dissection in 76, laparoscopic or open extra-vesical excision in 31 and 42 respectively, and transurethral dissection and pluck in 163. 114(28.4%) patients had a bladder recurrence during follow-up. There was no difference in B-RFS between lower-end techniques by Kaplan-Meier (p = 0.94). When all factors were taken into account by adjusted Cox-regression, preceding ureteroscopy (HR 2.65, p = 0.001), lower ureteric tumour location (HR 2.16, p = 0.02), previous bladder cancer (HR 1.75, p = 0.01) and male gender (HR 1.61, p = 0.03) were associated with B-RFS. CONCLUSION: These data suggest in appropriately selected patients, lower ureteric management technique does not affect B-RFS. Along with lower ureteric tumour location, male gender and previous bladder cancer, preceding ureteroscopy was associated with a higher recurrence rate following NU, and the indication for this should be carefully considered.

Role of platelet rich plasma in fracture non-union of scaphoid - Case series.

This case series of 4 patients was studied at Queen Mary Hospital, Hong Kong from 2007 to 2011 to evaluate the clinical and radiological outcome of scaphoid fracture non-union treated with Open reduction and internal fixation ORIF supplemented with Bone Graft (BG) from iliac crest and Platelet Rich Plasma PRP. The purpose was to achieve union with pain free adequate range of movement. Patients presenting with scaphoid fracture non-union were included in our study. Total 4 patients with an average age of 35±7.7 years (range 31 to 47 years) and mean follow-up of 21.75±14.97 months, (range 05 months to 3.5 years) were included. All patients achieved union with pain free Range of motion of wrist as well as thumb. We recommend open reduction and internal fixation with bone graft along with platelets rich plasma for non-union of scaphoid.

New technique: tendon interposition arthroplasty in Distal Interphalangeal Joint arthritis in Chinese population - New horizon for treatment.

OBJECTIVE: To evaluate the clinical outcome of managing distal inter-phalangeal joint arthritis by using excisional arthroplasties with soft-tissue interposition to provide pain-free joint with adequate range of motion and preserving the bone stock. METHODS: The case series was conducted at Queen Mary Hospital, Hong Kong from 2013 to 2015 and comprised patients with distal inter-phalangeal joint arthritis. Excisional arthroplasty was performed for all patients. Interposition was performed using extensor retinaculum/ palmaris longus. An axial K wire for 3-4 weeks was applied to maintain the reconstructed part in satisfactory alignment. Mallet splint was applied for another 3 weeks. Free active mobilisation was allowed afterward. Clinical assessment was done at least at 3, 6 and 12 months. RESULTS: There were three patients in the series, and all the 5 fingers, including one thumb, achieved good range of motion with no complication except in 1(33.3%) patient who needed re-exploration of index finger for retained suture with no documentary infection. All patients (100%) had significant pain relieved with mean visual analogue scale score of 3/10±SD at 3 months and 0/10 at 1-year follow-up. All achieved good range of motion. All (100%) were satisfied with postoperative surgical outcome. CONCLUSIONS: Interposition arthroplasty gave the patients adequate range of motion with preservation of bone stock.

A comparison between orthopedic surgeon and allied health worker in pirani score.

OBJECTIVE: To assess the strength of agreement for each of the Pirani assessment categories between an orthopaedic surgeon and allied health worker on scoring clubfeet. METHODS: The descriptive cross-sectional study was conducted at the Indus Hospital, Karachi, from November 2012 to June 2013, comprised children below 12 months of age with untreated unilateral or bilateral clubfoot deformity an allied health worker, who was a plaster technician, was given 1-week training in the Pirani Scoring method. The feet were scored by the surgeon and the paramedic independently. SPSS 21 was used for statistical analysis. RESULTS: The study had 57 patients, and 92 feet were assessed. The difference between the means of score of each parameter, including the hind foot score and total score, was less than 0.09. The means of total score were found to be identical. Total Hind Foot Score was 0.48 and Total Score was 0.354. The statistical inter-observer reliability for all components was rated as substantial to moderate agreement except Equinus Rigidityand Total Score, which showed fair agreement. CONCLUSIONS: Pirani scoring method for clubfoot assessment was found to be a reliable tool for use by plaster technicians for independent assessment of clubfoot. However, prior training and supervision in the early phase is necessary.

Perception about braces in parents of children with clubfoot.

OBJECTIVE: To access the acceptability of Steenbeek brace by children undergoing clubfoot correction and their parents to ensure long-term compliance. METHODS: The cross-sectional study was conducted at the Indus Hospital, Karachi from October 2013 to March 2014. A trained researcher interviewed the person primarily responsible for bracing the child using a pre-coded questionnaire. Modified Orthotics Prosthetics User Survey for satisfaction with either the Mitchell brace of the Steenbeek brace was used. It included 11 questions in the Parent Bracing Satisfaction Survey. SPSS 21 was used for statistical analysis. RESULTS: Interviews were completed with 110 primary caregivers among whom 90(81.8%) were mothers. Overall, 32(29.1%) children were using the Mitchell brace, 30(27.3%) the Steenbeek brace, 46(41.8%) had shifted from Mitchell to Steenbeek brace, and 2(1.8%) had shifted from Steenbeek to Mitchell brace. Median duration of current brace usage was 4 and 3.5 months for Steenbeek and Mitchell braces respectively. The mean age of the child was 1.4 ±0.7 years, and the mean of 4-point Likerts cale score of parent bracing satisfaction was 28.7±2.2 in children on the Mitchell brace versus 28.5±1.9 for those on Steenbeek brace (p=0.505). Overall, 82(74.5%) parents had favourable attitude towards braces in general, but there were no significant differences in the items except "brace is easy to put on" (p=0.040) and "durability between Mitchell and Steenbeek groups" (p=0.017). CONCLUSIONS: There were no differences in satisfaction levels between the two types of brace users.

Significance of strontium ranelate in healing of surgically fixed tibial diapyseal fractures treated with strontium ranelate vs placebo; a randomised double blind controlled trial.

OBJECTIVE: To determine the surgical outcome of patients with axial cervical spine fractures. METHODS: The randomised double-blinded placebo-controlled clinical study was conducted at the Indus Hospital, Karachi, from August 2011 to August 2013. Patients were randomised to receive placebo or strontium ranelate postoperatively after surgical fixation of tibial diaphyseal fractures. Assessment of fracture healing was done clinically and radiologically at 30, 60 and 90 days. SPSS 21 was used for statistical analysis. RESULTS: Initially, 76 patients were enrolled, but 63(82.9%) completed the study. Out of 63 patients, 32(50.8%) were randomly assigned to group A and 31(49.2%) to group B, which was administered the placebo. Overall enhancement of fracture healing efficacy of strontium ranelate group was 20(62.5%) versus 9(29%) of the placebo group. CONCLUSIONS: Strontium ranelate was effective in enhancing fracture healing based on clinical and radiological assessment. Hence, it can be considered an effective therapeutic agent for accelerating fracture healing.

Anthropomorphic mismatch between distal femurs and a standard total knee replacement system in Pakistani population.

AIMS: To compare the measurements of distal femurs of a Pakistani population and with the implants used. METHODS: The single-centre prospective cross-sectional study was conducted at the Indus Hospital, Karachi, from 01-06-2011 to 31-10-2011, and comprised total knee replacement patients. Surgeries were performed by the same team. Each measurement was taken after the resection of the trochlea (flush to the anterior femoral cortex), the distal cut and the anterior chamfer cuts. Measurements were taken intraoperatively with a sterile vernier calliper. SPSS 17was used to analyse the data. RESULTS: The mean age of the 33 patients in the study was 59.3±7years. There were 4(12.1%) males and 29(87.9%) females. A mismatch was found in per-operative measurements with the mean aspect ratio being 0.79±0.05and the standardised aspect ratio of the implants being 0.90 (SD±0.0). CONCLUSIONS: There are differences between anthropomorphometry of our skeleton and Caucasian designed implants. This could have implications in the long term.

Photocatalysis and perovskite oxide-based materials: a remedy for a clean and sustainable future.

The massive use of non-renewable energy resources by humankind to fulfill their energy demands is causing severe environmental issues. Photocatalysis is considered one of the potential solutions for a clean and sustainable future because of its cleanliness, inexhaustibility, efficiency, and cost-effectiveness. Significant efforts have been made to design highly proficient photocatalyst materials for various applications such as water pollutant degradation, water splitting, CO2 reduction, and nitrogen fixation. Perovskite photocatalyst materials are gained special attention due to their exceptional properties because of their flexibility in chemical composition, structure, bandgap, oxidation states, and valence states. The current review is focused on perovskite materials and their applications in photocatalysis. Special attention has been given to the structural, stoichiometric, and compositional flexibility of perovskite photocatalyst materials. The photocatalytic activity of perovskite materials in different photocatalysis applications is also discussed. Various mechanisms involved in photocatalysis application from wastewater treatment to hydrogen production are also provided. The key objective of this review is to encapsulate the role of perovskite materials in photocatalysis along with their fundamental properties to provide valuable insight for addressing future environmental challenges.

Late chronic inflammatory reaction post-silastic sling insertion masquerading as an invasive bladder tumour.

There are various surgical techniques to treat female stress urinary incontinence. We present the case of a long-term complication in a lady, where a silastic sling caused a massive retropubic fibrous reaction, masquerading, clinically and radiologically, as a muscle invasive bladder cancer.