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Dysphagia Outcomes in Zenker Diverticulum: A Longitudinal POuCH Study
No full textOBJECTIVE: Patients with cricopharyngeus muscle dysfunction (CPMD) with and without diverticula (e.g., Zenker Diverticulum) often struggle with dysphagia for years prior to diagnosis or intervention. Surgical treatment is successful; yet, there is limited long-term data on dysphagia outcomes after surgery.
METHODS: Individuals prospectively enrolled in the Prospective Outcomes of Cricopharyngeal Hypertonicity (POuCH) collaborative with and without diverticula who underwent surgery from November 2014 to August 2024 and had at least 12 months of follow-up were included. Eating Assessment Tool 10 (EAT10) was used to characterize patient-reported outcomes. Descriptive statistics were performed using means, frequencies, and spaghetti plots.
RESULTS: Of 164 patients initially identified, 2 withdrew and 2 were excluded for incomplete data; 160 were included. 31% were women, with a mean (SD) age of 70.1 (11.5). Endoscopic surgery (113, 71%) was more common than open technique (47, 29%). 19.4% of patients had undergone previous surgery. Postoperatively, patients were found to have improved EAT-10 scores, with smaller changes recorded after 36 months. Median change in EAT-10 compared to preoperative score was -12 points [IQR: -18, -5] at 12 months. 39 (24%) patients were followed for \u3e 24 months (median change -11 [IQR: -14, -7]); 26 (16%) \u3e 36 months (-9.5 [-17, -5]), and 12 (7.5%) \u3e 48 months (-4 [IQR: -18, 4]). Six patients died during the study period.
CONCLUSION: Improved dysphagia after surgery appears stable with minimal change over time. Most patients (96.3%) survive at least 1 year. Surgical intervention for patients with CPMD with or without diverticula is an effective and reliable treatment option
Intraparenchymal Anaplastic Meningioma With Isolated Motor Deficits
No full textThis case report describes a 62-year-old female with a history of gastroesophageal reflux disease and irritable bowel syndrome who presented with progressively worsening left-sided weakness and gait instability of two weeks\u27 duration. A CT of the head without contrast revealed a 3.7 × 3.6 cm right frontal lobe mass with vasogenic edema and significant midline shift. A subsequent brain MRI with and without contrast demonstrated a 5.8 × 4.6 × 4.2 cm intra-axial, aggressive-appearing mass centered posteriorly within the right frontotemporal lobe, with extensive surrounding edema and local mass effect. The patient underwent surgical resection via craniotomy, with subsequent resolution of focal deficits. Histopathology confirmed an anaplastic meningioma, WHO Grade III, despite the fact that meningiomas are typically extra-axial tumors. This case underscores that high-grade meningiomas, although rare, can present in unexpected ways and at unpredictable sites, creating diagnostic challenges. It also emphasizes the importance of timely neurosurgical intervention to improve the chances of recovery
Efficacy and Safety of Anticoagulants in Patients With Cirrhosis and Portal Vein Thrombosis: A Systematic Review and Meta-Analysis of Randomized and Non-Randomized Studies
No full textBACKGROUND: Portal vein thrombosis (PVT) contributes substantially to morbidity and mortality in cirrhotic patients. A clear insight into the anticoagulation therapy benefits in these patients could improve clinical decision-making. This meta-analysis aimed to assess the efficacy and safety of Anticoagulants in cirrhotic patients with PVT.
METHODS: PubMed, Cochrane Library, and ScienceDirect were searched from inception to September 2024. The Risk Ratios (RR) with 95% Confidence Interval (CI) were pooled for dichotomous outcomes under the random effects model using Review Manager 5.4.1. The primary endpoint of interest is PVT recanalization. Quality assessment was done through the Newcastle Ottawa Scale and the Cochrane RoB2.0 tool. Leave-one-out sensitivity analysis was done to investigate the cause of heterogeneity. Publication bias was assessed through funnel plots.
RESULTS: Twenty-three studies (including 19 cohorts and 4 Randomized trials), pooling 81,599 patients, were included in the analysis. Anticoagulants significantly increased the PVT recanalization (RR = 2.00; 95% CI: [1.59, 2.52]; p \u3c 0.00001; I (2) = 13%), PVT improvement (RR = 1.98; 95% CI: [1.70, 2.29], p \u3c 0.00001; I (2) = 0%) while decreasing the PVT stability (RR = 0.78; 95% CI: [0.62,0.99], p = 0.04; I (2) = 19%) and PVT progression (RR = 0.42; 95% CI: [0.29, 0.60], p \u3c 0.00001; I (2) = 27%). Other outcomes including mortality (RR = 0.53; 95% CI: [0.27, 1.03]; p = 0.06; I (2) = 94%), total bleeding (RR = 1.02; 95% CI: [0.76, 1.37], p = 0.89; I (2) = 31%), esophageal variceal bleeding (RR = 0.74; 95% CI: [0.54, 1.01], p = 0.06; I (2) = 56%), Gastrointestinal bleeding (RR = 1.07; 95% CI: [0.78, 1.48]; p = 0.66, I (2) = 13%) and Intracranial hemorrhage (RR = 1.19; 95% CI: [0.89, 1.58], p = 0.24, I (2) = 0%) were comparable between the 2 arms.
CONCLUSION: Anticoagulants significantly increased PVT recanalization and PVT improvement while decreasing PVT stability and PVT progression in cirrhotic patients. Other outcomes were comparable between the two groups
Improving the histologic detection of donor-specific antibody-negative antibody-mediated rejection in kidney transplants
No full textEmerging treatments for antibody-mediated rejection (ABMR, NEJM391 (2):122-132) have increased the importance of ABMR detection when donor-specific antibody (DSA) is negative. We addressed this issue in the Trifecta-Kidney study (ClinicalTrials.gov #NCT04239703) using 3 centralized tests in 690 kidney transplant biopsies: DSA (One Lambda Inc), blood donor-derived cell-free DNA (dd-cfDNA, Prospera™ test, Natera, Inc), and molecular biopsy assessment (MMDx). We used an AutoBanff 2022 algorithm to model the impact of alternative DSA interpretations on the histologic diagnosis of DSA-negative ABMR following Banff guidelines, including agreement with dd-cfDNA and molecular ABMR. Lowering MFI cutoffs for DSA positivity did not improve the detection of DSA-negative ABMR. However, simply calling all DSA as positive allowed the Banff 2022 guidelines to identify 46% more ABMR cases with no measurable conventional DSA, and per net reclassification improvement increased agreement between histologic diagnoses and both dd-cfDNA (P = 7.72E-7) and molecular ABMR (P = 7.69E-7). New ABMR cases were as strongly positive for dd-cfDNA and molecular ABMR as those found using the conventional DSA interpretation. A validation set analysis using INTERCOMEX study data (ClinicalTrials.gov NCT#01299168) confirmed these findings and found that the new DSA-negative ABMR cases identified by calling all DSA-positive had the same risk for graft loss as those found with conventional DSA interpretation. Trifecta-Kidney Study ClinicalTrials.gov #NCT04239703
Seizure and psychosocial outcomes in patients with DBS for intractable epilepsy
No full textOBJECTIVES: This study evaluates seizure outcomes in patients with intractable epilepsy treated with Deep Brain Stimulation (DBS) and explores correlations with demographic and psychosocial factors.
METHODS: We analyzed data from patients who underwent Medtronic-DBS implantation between 2018 and 2023 at our institution. Collected variables included sex, age, epilepsy type, prior epilepsy surgeries, age at diagnosis and DBS implantation, DBS lead location, seizure outcomes, anti-seizure medication (ASM) use, employment, Patient Reported Outcomes Measurement Information System (PROMIS) Depression T-scores pre- and post-DBS, antidepressant use, and driving status. Patients were classified as Total Responders (TR) if they achieved ≥ 50 % seizure reduction. Associations between responder status and assessed factors were analyzed using chi-square and Mann-Whitney U tests.
RESULTS: Seventeen patients (five males, twelve females; mean age 37.1 years, SD=10.7) were included, with an average epilepsy duration of 24.3 years (SD=13.1) before DBS. Leads were placed in the anterior thalamus (88 %) and centro-median nuclei (12 %). Fourteen patients (82 %) had multifocal epilepsy, while three (18 %) had symptomatic generalized epilepsy. TR status was achieved in 59 % of patients at a mean follow up of 32 months. Responder status correlated with higher ASM burden but not with other psychosocial factors.
CONCLUSION: DBS therapy resulted in \u3e 50 % seizure reduction in 59 % of patients with intractable epilepsy, with responders exhibiting a higher median ASM burden. While psychosocial factors were not significantly linked to seizure outcomes, TR patients demonstrated a relative worsening of Depression T-scores compared to non-responders, warranting further investigation
Commentary: How Do Robotics and Navigation Facilitate Minimally Invasive Spine Surgery? A Case Series and Narrative Review
No full textOsteoarthritis year in review 2025: Genetics, genomics, and epigenetics
No full textOBJECTIVE: This review provides an overview of the work performed in the realms of genetics, genomics and epigenetics in osteoarthritis (OA) research over the past year.
METHOD: A search was performed in the EMBASE database for original research articles and reviews published between March 2, 2024 and April 24, 2025. The search strategy consisted of the term osteoarthritis paired with keywords related to genetics, genomics and epigenetics. Articles were curated using Covidence software according to their relevance. For discussion in this review, priority was given to publications in top quartile rheumatology journals.
RESULTS: Our initial search identified 2240 unique articles, of which 42 are highlighted within this review. This year included the publication of the largest OA genetics study to date by the Genetics of Osteoarthritis Consortium. Higher impact OA genomics studies often involved the integration of multiple methodologies including chromatin accessibility mapping, single-cell RNA-sequencing and spatial transcriptomics analyses. Epigenetics studies included the characterization of non-coding RNAs, with an emphasis on microRNAs, in OA.
CONCLUSION: Over the past year, we saw significant advancements in the comprehensive molecular mapping of OA joint tissues. Further strides were made in the characterization of key OA-associated pathways, gene families and microRNAs that could be exploitable therapeutic targets
Local RANTES/CCL5 Delivery and Peripheral Blood Mobilization of Endogenous Marrow-Derived Mesenchymal Stem Cells to Mitigate Lumbar Intervertebral Disc Degeneration
No full textStudy Design: Translational rodent study.ObjectivesTo investigate (1) chemokine-mediated mesenchymal stem cell mobilization and homing to the intervertebral disc and (2) using this technique to mitigate intervertebral disc degeneration in a rat model.
Methods: (1) Recruitment of mesenchymal stem cells (MSCs) to intervertebral discs (IVD) was investigated using intradiscal chemokines. Hydrogel containing SDF-1, RANTES, MCP-1, or empty control was injected intradiscally, followed by near-infrared (NIR) imaging to observe MSC localization. (2) A rat IVD degeneration model was induced by annular puncture. Intradiscal RANTES injection and/or systemic AMD3100 injection was performed. Longitudinal imaging and histological analyses including Rutges Score (histologic degeneration) assessed IVD degeneration mitigation post-treatment up to 12-weeks. Statistical analyses included ANOVA and mixed-effects models to evaluate recruitment, retention, and regenerative potential of MSCs.
Results: (1) 24 rats were included in the investigation of MSC recruitment. In vivo NIR signal on 1-day post-intervention was highest with RANTES (P \u3c .05). Ex vivo NIR signal at 14-days post-intervention was highest with RANTES (P \u3c .05). (2) 36 IVD degeneration model rats underwent intradiscal RANTES and/or AMD3100 injection. AMD3100-treated groups showed larger nucleus pulposus (NP) volumes and reduced histologic damage, with lower Total Rutges scores (P = .004). RANTES treatment alone reduced Total Rutges scores (P = .009) and protected against IVD height loss at 6 weeks.
Conclusions: Intradiscal delivery of RANTES/CCL5 promotes a sustained and targeted recruitment of MSCs to the IVD. In a rat model of IVD degeneration, administration of systemic AMD3100 and intradiscal RANTES mitigates IVD degeneration
Iliac Epiphyseal Avulsion Repair Using a Suture Bridge and Lag Screw Construct
No full textApophyseal avulsion fractures in adolescents are not uncommon, particularly among young athletes participating in explosive sports. Typically, avulsion fractures around the pelvis occur associated with a forceful eccentric contraction, in which a tendon avulses its osseous origin from the underlying apophysis. An atypical or less commonly encountered avulsion fracture pattern involves the apophysis from the iliac wing extending distally to include the anterior superior iliac spine. This fracture pattern is subject to deforming forces from varying directions, which must be considered during fixation, as these are the attachment sites for both abdominal muscles and the origin of the sartorius. This Technical Note details a reduction and fixation technique for the treatment of an iliac apophyseal avulsion fracture. This approach leverages double-loaded anchors in the ilium in a suture-bridge construct, combined with lag screw boney compression and fixation. This hybrid approach addresses deforming forces from the abdominal musculature and sartorius while respecting soft tissue attachments and anatomic fracture fixation principles
Suture Button with Tension Band Fixation for Patella fractures: A Retrospective Case Series
No full textINTRODUCTION: There is a high rate of surgical complications and removal of symptomatic hardware for patients who have undergone open reduction internal fixation (ORIF) for transverse patella fractures. In recent years there has been increased interest in more low profile ORIF techniques to combat these issues. The aim of this study was to evaluate if a reduced hardware burden would correlate with fewer complications and equal rates of fracture union when compared to traditional techniques for treating transverse patella fractures.
METHODS: Nine patient charts were retrospectively reviewed dating between June 2015 and March 2023. All patients sustained a transverse patella fracture and underwent ORIF with a suture button and suture tension band construct by a single surgeon. The primary outcome measure was rate of radiographic fracture union at final follow up. Secondary outcome measures included any need for removal of hardware or other revision procedure, surgical and medical complications, postoperative pain score and the ability to perform a straight leg raise.
RESULTS: Eight of nine patients demonstrated radiographic evidence of fracture consolidation with an average follow-up time of 17.9 months (range 12-26 months). One patient required an additional operation for revision ORIF before going on to successful union. No patients underwent a procedure for removal of hardware before final follow up. All patients were able to hold a straight leg raise at final follow up.
CONCLUSIONS: Suture button with suture tension band construct is a reasonable treatment option for treating transverse patella fractures. Surgeons may employ this technique for older patients or those with some fracture comminution, although there should be some caution and close follow up for displacement