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European Journal of Ophthalmology May 2024This study aims to describe the ocular manifestations, treatment, and prognosis of OPMD patients registered in the national Israel OPMD(IsrOPMD) registry. (Review)
Review
PURPOSE
This study aims to describe the ocular manifestations, treatment, and prognosis of OPMD patients registered in the national Israel OPMD(IsrOPMD) registry.
METHODS
Data was prospectively collected from patients referred to the IsrOPMD registry from January 2022 to March 2023. This included patient demographics, medical and ocular history, eye exams, eyelid evaluations, visual field exams, and orthoptic evaluations.
RESULTS
30 patients (15 males, mean age 53 years) were treated in the ocular OPMD clinic, predominantly of Bukhari descent (86.6%). The mean visual acuity was 0.06 logMAR. Twenty-one patients (70%) had eye movement problem, mostly in horizontal gaze. 6(20%) patients' complaint about diplopia. Ptosis surgery was performed in 21(70%) patients, with 17(56.7%) patients underwent frontalis sling surgery and 4(13.3%) patients undergoing levator advancement. The mean Margin reflex distance (MRD1) improved post-surgery (2.28 mm vs. 1.58 mm), but 11(36.6%) patients required more than one ptosis surgery.
CONCLUSIONS
The study contributes valuable insights into the ocular aspects of OPMD. It reveals that OPMD patients often experience a range of ocular symptoms, such as ptosis, abnormalities in eye movements, strabismus, and potentially diplopia, which can significantly impact their quality of life. The findings underscore the importance of regular ophthalmological follow-up for these patients to address these symptoms effectively. The study is significant in contributing to the limited but growing knowledge about the ocular manifestations of OPMD and the management of these symptoms to improve the quality of life for patients suffering from this condition.
PubMed: 38809679
DOI: 10.1177/11206721241259145 -
International Journal of Paediatric... May 2024Mesiodens usually lead to the malposition and abnormal morphology of maxillary central incisors.
BACKGROUND
Mesiodens usually lead to the malposition and abnormal morphology of maxillary central incisors.
AIM
To evaluate the detrimental effects of single unilaterally impacted mesiodens on the three-dimensional positions and morphology of the maxillary central incisor using cone-beam computed tomographic (CBCT) examinations.
DESIGN
A total of 321 patients aged 5-17 years with single unilaterally impacted mesiodens were included and divided into two groups: mixed dentition group (5-10 years) and early permanent dentition group (11-17 years). CBCT data for these patients were retrospectively analyzed to compare the inclination, rotation, angulation, and morphology of maxillary central incisors between the affected and contralateral control sides. The morphology, orientation, and spatial location of mesiodens were also assessed.
RESULTS
Central incisors on the affected side showed significant palatal crown inclination, shorter root, shorter tooth, and greater crown-to-root ratio in both groups, whereas significant mesial crown angulation was only observed in the mixed dentition group.
CONCLUSION
Impacted mesiodentes result in the displacement and impaired root development of central incisors, strongly suggesting timely clinical management of these abnormal teeth, such as the early removal of mesiodens and orthodontic treatments.
PubMed: 38803007
DOI: 10.1111/ipd.13218 -
Structural Heart : the Journal of the... May 2024Treatment options for patients with mitral regurgitation (MR) and mitral annular calcification (MAC) are limited. The limitations of current transcatheter mitral valve...
BACKGROUND
Treatment options for patients with mitral regurgitation (MR) and mitral annular calcification (MAC) are limited. The limitations of current transcatheter mitral valve replacement (TMVR) technologies include high screen failure rates, increased risk of left ventricular outflow tract obstruction, and high residual regurgitation. The aim of this study was to evaluate outcomes of TMVR with the AltaValve system (4C Medical, Maple Grove, MN), a supra-annular TMVR with atrial fixation, in patients with severe MR and moderate or severe MAC.
METHODS
Six patients with moderate or severe MAC who were treated with AltaValve TMVR had procedural and mid-term outcomes available.
RESULTS
Technical success was achieved in all patients. Median follow-up was 232 days. At discharge, 80% of patients had none/trace MR, and 20% had mild MR. There was no intraprocedural mortality, device malposition, embolization, or thrombosis. One patient expired 3 days postprocedure due to complications related to the transapical access. All other patients were discharged from the hospital without issues. Echocardiography assessments at 30 days showed complete resolution of MR in all patients, with 1 patient with mild MR and a mean mitral valve gradient of 3.7 ± 1.4 mmHg. All patients were in New York Heart Association Class I/II at 30-day follow-up, showing marked improvement as compared with baseline.
CONCLUSIONS
In patients with severe MR and severe MAC, the AltaValve TMVR technology may represent a viable treatment option. The atrial fixation minimizes the risk of left ventricular outflow tract obstruction and potentially expands treatable patients, especially in patients with MAC.
PubMed: 38799804
DOI: 10.1016/j.shj.2024.100294 -
Reumatologia 2024Total hip arthroplasty (THA) is nowadays considered as the most effective treatment option for end-stage hip osteoarthritis (OA) and one of the most successful...
INTRODUCTION
Total hip arthroplasty (THA) is nowadays considered as the most effective treatment option for end-stage hip osteoarthritis (OA) and one of the most successful orthopedic procedures. Precise reproduction of the center of rotation (COR) is among the most important aspects of recreating native hip biomechanics after THA as it is strictly related to muscle tension and force distribution within the hip joint. Both vertical and horizontal shift in cup positioning and COR restoration are commonly observed radiological signs corresponding with lesser functional outcome. The aim of this study was to assess whether the superior border of the native acetabulum morphology has an impact on cup positioning and COR restoration in patients undergoing THA as treatment of primary OA of the hip.
MATERIAL AND METHODS
A cohort of 150 consecutive patients with diagnosis of end-stage primary hip OA who underwent THA via an anterolateral approach with the same implant in 2021 was analyzed retrospectively. Standard standing pelvic X-rays were performed pre- and postoperatively and appropriate measurements were taken. Several radiological parameters on obtained X-rays were assessed. Statistical analysis of all the measurements was performed.
RESULTS
There was a statistically significant positive weak correlation between cup offset and acetabular roof angle ( = 0.25, = 0.002). There were statistically insignificant positive correlations between acetabular roof angle and COR restoration ( = 0.14, = 0.097), acetabular roof angle and total offset ( = 0.087, = 0.29) and a negative correlation between acetabular roof angle and femoral offset ( = 0.071, = 0.39).
CONCLUSIONS
The present study revealed that preoperative acetabular roof angle influences the positioning of the prosthetic cup in the transverse axis. There also seems to be a correlation between the acetabular roof angle and COR restoration, but its significance needs further evaluation. Surgeons could use this knowledge to preoperatively assess the risk of cup malposition and adjust their technique during the THA procedure with probable improvement of hip function.
PubMed: 38799773
DOI: 10.5114/reum/186724 -
HeartRhythm Case Reports May 2024
PubMed: 38799594
DOI: 10.1016/j.hrcr.2024.02.009 -
Journal of Imaging Apr 2024The position of the fetal head during engagement and progression in the birth canal is the primary cause of dystocic labor and arrest of progression, often due to...
The position of the fetal head during engagement and progression in the birth canal is the primary cause of dystocic labor and arrest of progression, often due to malposition and malrotation. The authors performed an investigation on pregnant women in labor, who all underwent vaginal digital examination by obstetricians and midwives as well as intrapartum ultrasonography to collect four "geometric parameters", measured in all the women. All parameters were measured using artificial intelligence and machine learning algorithms, called AIDA (artificial intelligence dystocia algorithm), which incorporates a human-in-the-loop approach, that is, to use AI (artificial intelligence) algorithms that prioritize the physician's decision and explainable artificial intelligence (XAI). The AIDA was structured into five classes. After a number of "geometric parameters" were collected, the data obtained from the AIDA analysis were entered into a red, yellow, or green zone, linked to the analysis of the progress of labor. Using the AIDA analysis, we were able to identify five reference classes for patients in labor, each of which had a certain sort of birth outcome. A 100% cesarean birth prediction was made in two of these five classes. The use of artificial intelligence, through the evaluation of certain obstetric parameters in specific decision-making algorithms, allows physicians to systematically understand how the results of the algorithms can be explained. This approach can be useful in evaluating the progress of labor and predicting the labor outcome, including spontaneous, whether operative VD (vaginal delivery) should be attempted, or if ICD (intrapartum cesarean delivery) is preferable or necessary.
PubMed: 38786561
DOI: 10.3390/jimaging10050107 -
Diagnostics (Basel, Switzerland) May 2024This case concentrates on the persistent left superior vena cava (PLSVC), a rare vascular anomaly which contributes to central venous catheter (CVC) misplacement. A...
This case concentrates on the persistent left superior vena cava (PLSVC), a rare vascular anomaly which contributes to central venous catheter (CVC) misplacement. A 72-year-old woman with renal insufficiency presented to the hospital with recurrent bleeding from her permanent CVC device placed in the right common jugular vein. An initial attempt to replace the device was unsuccessful, necessitating the placement of a secondary catheter in the left jugular vein. Shortly after the procedure, the patient developed swelling of the face and neck. Further diagnostic imaging, including a chest radiograph and computed tomography (CT), revealed CVC misplacement in the PLSVC and coronary sinus, thrombosis of the common jugular vein, and a posterior mediastinal hematoma. Conservative therapy of the mediastinal hematoma was implemented and proved effective in this case. A temporary CVC was inserted into the left femoral vein. Two months later, the catheter underwent further dysfunction and a decision was made to place a long-term permanent CVC via the right femoral vein. The patient is currently awaiting an arteriovenous fistula for dialysis use. This case emphasizes the importance of radiological techniques for CVC procedural placement, as well as the detection of congenital abnormalities. Providers regularly placing CVCs should have an in-depth knowledge of the possible complications and potential anatomical variations, especially as seen in high-risk patients.
PubMed: 38786336
DOI: 10.3390/diagnostics14101038 -
Journal of Oral Rehabilitation May 2024Mandibular malpositioning may result in an abnormal concentration of stresses within the temporomandibular joint (TMJ) in adult rats, which may further lead to a series...
Influence on the temporomandibular joint induced by mandibular malpositioning caused by vertical dimension elevation and occlusal loss in adult rats: An imaging, histological and immunohistochemical study.
BACKGROUND
Mandibular malpositioning may result in an abnormal concentration of stresses within the temporomandibular joint (TMJ) in adult rats, which may further lead to a series of pathological changes, such as articular cartilage wear, subchondral bone sclerosis and osteophyte formation. However, the pathological and adaptive changes in condylar cartilage caused by different stress distributions are still controversial.
OBJECTIVE
The aim of this study was to observe the effect of sagittal changes in mandibular position on condylar cartilage by changing the occlusal vertical dimension (OVD) in adult rats.
METHODS
Fifteen-week-old female rats were divided into three groups: control (CON), increased OVD (iOVD) and loss of occlusion (LO) groups. An occlusal plate and tooth extraction were used to establish the animal model. TMJ samples of the experimental and CON groups were observed and investigated by bone morphological, histomorphological and immunohistochemical staining analyses at 3 days, 1 week, 2 weeks, 4 weeks and 8 weeks. Weight curves were plotted.
RESULTS
Micro-computed tomography showed that, compared with the CON group, cartilage destruction followed by repair occurred in both experimental groups, which was similar to the trend observed in haematoxylin-eosin staining. All experimental results for the iOVD group showed an approximately similar time trend. Compared with the iOVD group, the toluidine blue and immunohistochemical staining results in the LO group showed no obvious change trend over time.
CONCLUSION
Compared with occlusal loss, an increase in OVD caused faster and more severe damage to condylar cartilage, and subchondral bone repair occurred later.
PubMed: 38783585
DOI: 10.1111/joor.13739 -
The Journal of Arthroplasty May 2024Hip resurfacing arthroplasty (HRA) is a bone-conserving alternative to total hip arthroplasty. We present the 2-year clinical and radiographic follow-up of a novel...
BACKGROUND
Hip resurfacing arthroplasty (HRA) is a bone-conserving alternative to total hip arthroplasty. We present the 2-year clinical and radiographic follow-up of a novel ceramic-on-ceramic HRA in an international multicenter cohort.
METHODS
Patients undergoing HRA between September 2018 and January 2021 were prospectively included. Patient-reported outcome measures (PROMs) in the form of the Forgotten Joint Score, Hip Disability and Osteoarthritis Outcome Score Jr., Western Ontario and McMaster Universities Arthritis Index, Oxford Hip Score, and University of California, Los Angeles, Activity Score were collected preoperatively, and at 1 and 2 years postoperation. Serial radiographs were assessed for migration, component alignment, evidence of osteolysis or loosening, and heterotopic ossification formation.
RESULTS
The study identified 200 patients who reached a minimum 2-year follow-up (mean 3.5 years). Of these, 185 completed PROMs follow-up at 2 years. There was a significant improvement in Hip Disability and Osteoarthritis Outcome Score (P < .001) and Oxford Hip Score (P < .001) between the preoperative, 1-year, and 2-year outcomes. Patients had improved activity scores on the University of California, Los Angeles, Active Score (P < .001), with 45% reporting a return to high-impact activity at 2 years. At 1 and 2 years, the Forgotten Joint Score was not significantly different (P = .38). There was no migration, osteolysis, or loosening of any of the implants. No fractures were reported over the 2-year follow-up, with only 1 patient reporting a sciatic nerve palsy. There were 2 revisions, 1 for unexplained pain at 3 months due to acetabular component malposition and 1 at 33.5 months for acetabular implant failure.
CONCLUSIONS
The ceramic-on-ceramic resurfacing at 2 years postoperation demonstrates promising results with satisfactory outcomes in all recorded PROMs. Further long-term data are needed to support the widespread adoption of this prosthesis as an alternative to other HRA bearings.
PubMed: 38782243
DOI: 10.1016/j.arth.2024.05.042 -
Journal of Plastic, Reconstructive &... Jul 2024Implant rotation is a known complication to breast reconstruction using anatomical implants. However, there is a lack of large studies investigating the risk of implant...
BACKGROUND
Implant rotation is a known complication to breast reconstruction using anatomical implants. However, there is a lack of large studies investigating the risk of implant rotation and potential predisposing risk factors.
METHOD
We reviewed the medical records of all patients who underwent breast reconstruction with Mentor anatomical implants from 2010 to 2021 at two Danish hospitals. We compared the risk of implant rotation between one- and two-stage breast reconstruction using univariate logistic regression. We analyzed the effect of biological mesh, immediate versus delayed reconstruction, and use of a higher final expander volume than the permanent implant volume on the risk of implant rotation. Finally, we analyzed the success rate of revision surgery for implant rotation.
RESULTS
In total, 1134 patients were enrolled. Patients who underwent two-stage breast reconstruction (n = 720) had a significantly higher risk of implant rotation than those who underwent one-stage breast reconstruction (n = 426; 11% vs. 5%, p < 0.01). There was no significant association between implant rotation and the use of biological mesh, immediate breast reconstruction, or use of a higher final expander volume than the permanent implant volume. The success rate of revision surgery after implant rotation was 73% (62/85 rotations).
CONCLUSIONS
Two-stage breast reconstruction significantly increased the risk of implant rotation compared to one-stage breast reconstruction. The overall risk of implant rotation was low and success rate of revision surgery was high. These findings suggest that anatomical implants are safe to use for breast reconstruction. However, surgeons and patients should be aware of the increased risk of implant rotation after two-stage reconstruction.
Topics: Humans; Female; Retrospective Studies; Middle Aged; Breast Implants; Reoperation; Breast Implantation; Adult; Risk Factors; Breast Neoplasms; Postoperative Complications; Mammaplasty; Denmark; Prosthesis Failure
PubMed: 38781835
DOI: 10.1016/j.bjps.2024.05.018