256 research outputs found
sj-docx-1-onc-10.1177_11795549221116834 – Supplemental material for Concordance of Genomic Profiles in Matched Tissue and Plasma Samples From Chinese Patients With Lung Cancer
No full textSupplemental material, sj-docx-1-onc-10.1177_11795549221116834 for Concordance of Genomic Profiles in Matched Tissue and Plasma Samples From Chinese Patients With Lung Cancer by Yueming He, Weifeng Guo, Meng Xu, Junling Huang, Xiange Zhang, Huanzhang Su, Dongxia Hong and Qun Liu in Clinical Medicine Insights: Oncology</p
sj-xlsx-2-onc-10.1177_11795549221116834 – Supplemental material for Concordance of Genomic Profiles in Matched Tissue and Plasma Samples From Chinese Patients With Lung Cancer
No full textSupplemental material, sj-xlsx-2-onc-10.1177_11795549221116834 for Concordance of Genomic Profiles in Matched Tissue and Plasma Samples From Chinese Patients With Lung Cancer by Yueming He, Weifeng Guo, Meng Xu, Junling Huang, Xiange Zhang, Huanzhang Su, Dongxia Hong and Qun Liu in Clinical Medicine Insights: Oncology</p
Low-PAPR layered/enhanced ACO-SCFDM for optical-wireless communications
No full textIn this letter, we propose layered/enhanced asymmetrically clipped optical single-carrier frequency-division multiplexing (L/E-ACO-SCFDM) for optical-wireless communications. L/E-ACO-SCFDMhas a lower computational complexity and peak-to-average power ratio (PAPR) than L/E-ACO orthogonal frequency-division multiplexing (L/E-ACO-OFDM). The computational complexity of the simplified transmitter in L/EACO-SCFDM with R layers is (2 - 2/2R)O(N), which is lower than the computational complexity of (2 - 2/2R)O(Nlog2N) in L/E-ACO-OFDM. At a complementary cumulative distribution function of 10-3, the PAPR of L/E-ACO-SCFDM is approximately 4.2, 3.4, and 2.7 dB lower than that of L/E-ACO-OFDM for 2, 3, and 4 layers, respectively. The simulation results indicate that L/E-ACO-SCFDM has better performance than L/E-ACOOFDM under the transmitter nonlinearity and multipath fading.</p
Variables influencing radiological fracture healing in children with femoral neck fractures treated surgically: A review of 177 cases
No full textPurpose: This study aimed: (1) to determine the probability of and the amount of time needed to achieve fracture healing in children with displaced femoral neck fractures (FNFs) treated surgically; and (2) to determine which factors can affect both the probability of and the amount of time needed to achieve radiological fracture healing in those patients. Hypothesis: Pediatric FNFs require longer time to achieve union than previously reported. Methods: We retrospectively reviewed the data of 177 children (mean age 10.5 ± 3.9 years) with FNFs treated surgically. Risk factors, including age, sex, laterality, the mechanism of injury, the initial displacement severity, the type of fracture, the time to reduction, the reduction method, the fixation method and the reduction quality, were recorded. Furthermore, the presence of a comminuted medial or posterior cortex on anteroposterior (AP) or lateral radiographs was also recorded. Results: A total of 172 hips (97.2%) achieved radiological fracture healing during the follow-up period. Severe initial displacement, a comminuted cortex on the AP or lateral radiographs and poor reduction quality significantly increased the time needed to achieve radiological fracture healing (p < 0.05). Cox regression analysis indicated that the cumulative probability of achieving fracture healing increased linearly during the first 6 months and then plateaued, with a monthly increase of less than 5%. The severity of initial displacement, presence/absence of comminution on the medial or posterior cortex, and reduction quality were factors influencing the probability of achieving fracture healing within the first 6 months after injury (p < 0.05). Conclusions: Radiological union of displaced pediatric FNFs treated surgically increases linearly during the first six month after surgery and then it tends to plateau. Risk factors for nonunion are severe initial displacement, poor reduction quality and the presence of comminuted medial or posterior cortex on AP or lateral radiographs; the same factors are associated with a longer time to achieve fracture healing. Level of evidence: III
Radiographic outcome of children older than twenty-four months with developmental dysplasia of the hip treated by closed reduction and spica cast immobilization in human position: a review of fifty-one hips
No full textPurpose: This study aimed to investigate the radiographic outcomes, rate of redislocation, and avascular necrosis of proximal femoral epiphysis (AVN) in patients aged 24 to 36 months with developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization in human position. Material and methods: We reviewed the medical records of 39 patients (51 hips) aged 24 to 36 months with DDH treated by CR and spica cast immobilization in human position. The Tönnis grade, rate of redislocation and AVN, acetabular index (AI), centre-edge angle (CEA), and Severin radiographic grade were evaluated on plain radiographs. Results: Among the included 39 patients (51 hips), 15 hips (29.4%) were Tönnis grade II, 24 hips (47.1%) were grade III, and 12 hips (23.5%) were grade IV. In 47 hips (92.2%), the ossific nucleus was present at the time of CR. Stable reduction was achieved by CR in 39/51 hips (76.5%) and redislocation occurred in 12/51 hips (23.5%). Among the 12 hips that redislocated, 11 underwent open reduction and one repeated CR. Two out of 40 hips (5%) treated by CR developed AVN. Overall, 54.6% of the hips had satisfactory outcomes (39.2% Severin type I and 17.6% type II), while 45.4% had unsatisfactory outcomes (39.2% Severin type III and 3.9% type IV). Of the 40 hips treated by CR, 57.5% and 42.5% of cases had satisfactory outcomes and residual acetabular dysplasia, respectively. Six out of 11 hips (54.6%) treated by open reduction and pelvic osteotomy had satisfactory outcomes. Conclusions: Our study showed that stable CR could be achieved in 76.5% of patients aged 24 to 36 months with DDH at the time of index procedure. Satisfactory outcomes can be expected in 56.4% of the cases (5.0% AVN rate), although late acetabular dysplasia may develop in 43.6% of the hips
The Duration of Hardware Retention After Radiologic Union of Surgically Treated Femoral Neck Fractures in Children May Predict the Aggravation or Occurrence of Avascular Necrosis of the Femoral Head or Neck After Hardware Removal
No full textBackground: The incidence of aggravation or occurrence of avascular necrosis (AVN) following hardware removal in surgically treated pediatric femoral neck fractures who achieved radiologic consolidation is unknown. This study aimed to investigate the risk factors for this complication.
Methods: Seventy-one pediatric (mean age: 9.8± 3.9 y) were retrospectively analyzed. Risk factors (age, sex, laterality, severity of initial displacement, type of fracture, time from trauma to reduction, reduction and fixation method, quality of reduction, time required to achieve radiologic union, duration of hardware retention, presence of AVN before hardware removal and follow-up time) were recorded. The severity of AVN was
assessed based on radiographs with Ratliff’s classification.
Results: Following hardware removal, the aggravation/occurrence of AVN was detected in 11 hips (15.5%). Among the 5 hips (7%) with aggravation of AVN, 1 (1.4%) with type II AVN and 3 (4.2%) with type III AVN exhibited aggravation of type I AVN, while the remaining hip (1.4%; type I) showed enlargement of the involved AVN area. Six hips (8.5%) developed AVN following hardware removal: 2 (2.8%) were classified as type I and 4 (5.6%) as type III. Receiver operating characteristic curve analysis indicated that hardware retention >7 months after union is associated with a decreased rate of aggravation or occurrence of AVN of the femoral neck or head following hardware removal.
Conclusions: The incidence of aggravation or occurrence of AVN following hardware removal in surgically treated pediatric femoral neck fractures is 15.5%; hardware retention > 7 months after radiologic union may reduce the risk of aggravation or occurrence of AVN of the femoral neck or head postimplant removal.
Level of evidence: Level III.Background: The incidence of aggravation or occurrence of avascular necrosis (AVN) following hardware removal in surgically treated pediatric femoral neck fractures who achieved radiologic consolidation is unknown. This study aimed to investigate the risk factors for this complication. Methods: Seventy-one pediatric (mean age: 9.8± 3.9 y) were retrospectively analyzed. Risk factors (age, sex, laterality, severity of initial displacement, type of fracture, time from trauma to reduction, reduction and fixation method, quality of reduction, time required to achieve radiologic union, duration of hardware retention, presence of AVN before hardware removal and follow-up time) were recorded. The severity of AVN was assessed based on radiographs with Ratliff’s classification. Results: Following hardware removal, the aggravation/occurrence of AVN was detected in 11 hips (15.5%). Among the 5 hips (7%) with aggravation of AVN, 1 (1.4%) with type II AVN and 3 (4.2%) with type III AVN exhibited aggravation of type I AVN, while the remaining hip (1.4%; type I) showed enlargement of the involved AVN area. Six hips (8.5%) developed AVN following hardware removal: 2 (2.8%) were classified as type I and 4 (5.6%) as type III. Receiver operating characteristic curve analysis indicated that hardware retention >7 months after union is associated with a decreased rate of aggravation or occurrence of AVN of the femoral neck or head following hardware removal. Conclusions: The incidence of aggravation or occurrence of AVN following hardware removal in surgically treated pediatric femoral neck fractures is 15.5%; hardware retention > 7 months after radiologic union may reduce the risk of aggravation or occurrence of AVN of the femoral neck or head postimplant removal. Level of evidence: Level III
Factors influencing outcomes of pelvic osteotomy for residual acetabular dysplasia following closed reduction in patients with developmental dysplasia of the hip
No full textAffiliations Expand
PMID: 37610089 DOI: 10.1097/BPB.0000000000001117
Abstract
To investigate the factors influencing outcome of pelvic osteotomy (PO) for residual acetabular dysplasia (RAD) following closed reduction (CR) in patients with developmental dysplasia of the hip (DDH). We retrospectively reviewed 91 patients (95 hips) with DDH who underwent PO for RAD. Tönnis grade, Acetabular index, Center Edge Angle, Reimer's Index (RI), and avascular necrosis of the femoral head (AVN) were assessed. Hips were divided into satisfactory (Severin I/II) and unsatisfactory group (Severin III/IV). Finally, 87 hips (91.5%) had satisfactory and 8 (8.5%) unsatisfactory outcomes. The RI before PO was significantly higher in unsatisfactory (49.6 ± 9%) than in satisfactory group (30.6%±11.8%). All patients without AVN had satisfactory outcome, while it was 78.9% of patients with AVN. Logistic regression analysis showed that higher AVN grade and RI before PO were risk factors for unsatisfactory outcome. Satisfactory outcome was obtained in all hips with RI < 33% before PO, while it was 79.5% if RI > 33% before PO (79.5%). There was no difference in the satisfactory rate between patients undergoing open reduction (66.7%) and those not undergoing (83.3%). The rate of satisfactory outcome in patients undergoing femoral osteotomy (63.6%) was lower than those without it (100%). In patients with RAD following CR, good outcome can be expected after PO alone. AVN and preoperative RI > 33% are risk factors for poor outcome. Additional open reduction and femoral osteotomy do not significantly improve outcome of PO in patients with preoperative RI > 33%.
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.To investigate the factors influencing outcome of pelvic osteotomy (PO) for residual acetabular dysplasia (RAD) following closed reduction (CR) in patients with developmental dysplasia of the hip (DDH). We retrospectively reviewed 91 patients (95 hips) with DDH who underwent PO for RAD. Tönnis grade, Acetabular index, Center Edge Angle, Reimer's Index (RI), and avascular necrosis of the femoral head (AVN) were assessed. Hips were divided into satisfactory (Severin I/II) and unsatisfactory group (Severin III/IV). Finally, 87 hips (91.5%) had satisfactory and 8 (8.5%) unsatisfactory outcomes. The RI before PO was significantly higher in unsatisfactory (49.6 ± 9%) than in satisfactory group (30.6%±11.8%). All patients without AVN had satisfactory outcome, while it was 78.9% of patients with AVN. Logistic regression analysis showed that higher AVN grade and RI before PO were risk factors for unsatisfactory outcome. Satisfactory outcome was obtained in all hips with RI < 33% before PO, while it was 79.5% if RI > 33% before PO (79.5%). There was no difference in the satisfactory rate between patients undergoing open reduction (66.7%) and those not undergoing (83.3%). The rate of satisfactory outcome in patients undergoing femoral osteotomy (63.6%) was lower than those without it (100%). In patients with RAD following CR, good outcome can be expected after PO alone. AVN and preoperative RI > 33% are risk factors for poor outcome. Additional open reduction and femoral osteotomy do not significantly improve outcome of PO in patients with preoperative RI > 33%
Effect of the Number, Size, and Location of Cannulated Screws on the Incidence of Avascular Necrosis of the Femoral Head in Pediatric Femoral Neck Fractures: A Review of 153 Cases
No full textBackground: The correlation between the number, size, and location of cannulated screws and the incidence of avascular necrosis (AVN) in children with femoral neck fractures treated surgically is uncertain. Methods: We retrospectively reviewed 153 children (mean age: 10.6±3.7 y) with femoral neck fractures treated by internal fixation with 2 (n=112) or 3 (n=41) cannulated screws. The severity of initial displacement was divided into incomplete (type I) and complete (type II, angulation <50 degrees; type III, angulation >50 degrees) fractures. The diameter of the screw was measured and recorded as a percentage of the femoral neck width. The distance (D) between the mid-point of each screw at the base (B) of the femoral neck and at the tip (T) of each screw and the superior and anterior cortices of the femoral neck, respectively, were measured on anteroposterior (AP) and lateral (L) radiographs. Values were expressed as the ratio between the measured distance and the width of the femoral neck (BDAP%, TDAP%, BDL%, and TDL%). The correlation between the number, size, and location of the screws and AVN was analyzed. Results: Patients with type II of initial displacement treated with 2 cannulated screws had a lower AVN rate (21.4%) than those treated with 3 screws (44.8%) (P=0.027). Screw diameter (19%) in patients with AVN was larger than (17%) in patients without AVN (P<0.001); patients with AVN had a lower BDAP% (48.6%) than those without AVN (56.4%) (P<0.001). Screw size and BDAP% were risk factors for AVN (P<0.05). Further, screw diameter >16.5% and BDAP% <51.6% of the femoral neck width were the cutoff values for an increased AVN rate (P<0.05). Conclusions: Patients treated with 2 cannulated screws showed a lower rate of AVN than patients treated with 3 screws. Screws of larger size and screws closer to the piriformis fossa on AP radiographs increased the risk of AVN in children with femoral neck fractures treated surgically. Level of Evidence: Level III
Risk factors for proximal radial abnormalities in children with untreated chronic Monteggia fractures: a review of 142 cases
No full textAbstract
Background The risk factors for proximal radial abnormalities (PRA) in paediatric patients with untreated chronic Monteggia fractures (CMFs) are unclear. This multicentre study aimed to evaluate the risk factors for PRA in children with untreated CMFs.
Materials and methods The clinical data of 142 patients (mean age at the time of injury: 5.73 years) with untreated unilateral CMFs were retrospectively reviewed. The radial neck-shaft angle (RNSAP) and radial head size (RHL) were measured on anteroposterior (AP) and lateral (L) radiographs, respectively. The RHL size was the ratio of the widest
width of the proximal radial metaphysis to the narrowest radial neck width. The En-RNSAP and En-RHL were the ratios of the enlargement (En) of the RNSAP angle and RHL
size of the injured elbow to those of the uninjured elbow, respectively. Paired-sample t-tests, single-factor analyses and multiple linear regression analyses were performed to evaluate the correlation between the differences in these parameters between the injured and uninjured elbows and the assessed risk factors. These risk factors included institution, sex, laterality, age at injury, time from injury to diagnosis, direction of RH dislocation, distance of RH dislocation (DD-RH), presence of radial or median nerve injury, heterotopic ossification and immobilization of the elbow after injury.
Results In children with untreated CMFs (mean time from injury to diagnosis: 14.6 months), Student’s t-test revealed a significant difference in the RHL size (P < 0.001) but not in the RNSAP angle (P = 0.075) between the injured and uninjured elbows. Pearson correlation analysis revealed a potential correlation between En-RHL and age at the time
of injury (P = 0.069), time from injury to diagnosis (P < 0.001) and DD-RH (P < 0.001), excluding other risk factors (P > 0.05). Multiple linear regression analysis revealed that age at the time of injury (P = 0.047), time from injury to diagnosis (P = 0.007) and DD-RH (P = 0.001) were risk factors for an increased En-RHL in patients with untreated CMFs; the variability in En-RHL among the other three risk factors was 21.4%.
Conclusions In paediatric patiens with unilateral untreated CMFs, PRA of the injured elbow consisted mainly of RH enlargement or radial neck narrowing rather than valgus deformities of the proximal radius. Older age at injury, increased time from injury to diagnosis and DD-RH were risk factors for more severe PRA.
Level of evidence III.Abstract
Background The risk factors for proximal radial abnormalities (PRA) in paediatric patients with untreated chronic Monteggia fractures (CMFs) are unclear. This multicentre study aimed to evaluate the risk factors for PRA in children with untreated CMFs.
Materials and methods The clinical data of 142 patients (mean age at the time of injury: 5.73 years) with untreated unilateral CMFs were retrospectively reviewed. The radial neck-shaft angle (RNSAP) and radial head size (RHL) were measured on anteroposterior (AP) and lateral (L) radiographs, respectively. The RHL size was the ratio of the widest width of the proximal radial metaphysis to the narrowest radial neck width. The En-RNSAP and En-RHL were the ratios of the enlargement (En) of the RNSAP
angle and RHL size of the injured elbow to those of the uninjured elbow,
respectively. Paired-sample t-tests, single-factor analyses and multiple linear regression analyses were performed to evaluate the correlation between the differences in these parameters between the injured and uninjured elbows and the assessed risk factors. These risk factors included institution, sex, laterality, age at injury, time from injury to diagnosis, direction of RH dislocation, distance of RH dislocation (DD-RH), presence of radial or median nerve injury, heterotopic ossification and immobilization of the elbow after injury.
Results In children with untreated CMFs (mean time from injury to diagnosis: 14.6 months), Student’s t-test revealed a significant difference in the RHL size (P < 0.001) but not in the RNSAP angle (P = 0.075) between the injured and uninjured elbows. Pearson correlation analysis revealed a potential correlation between En-RHL and age at the time of injury (P = 0.069), time from injury to diagnosis (P < 0.001) and DD-RH (P < 0.001), excluding other risk factors (P > 0.05). Multiple linear regression analysis revealed that age at the time of injury (P = 0.047), time from injury to diagnosis (P = 0.007) and DD-RH (P = 0.001) were risk factors for an increased En-RHL in patients with untreated CMFs; the variability in En-RHL among the other three risk factors was 21.4%
Is there an alternative to the Delbet-Colonna classification? Introduction and reliability assessment of a new classification system for paediatric femoral neck fractures: preliminary results
No full textAbstract
Purpose The purpose of this study was to introduce a new classification system for pediatric femoral neck fractures (PFNFs) and to evaluate its reliability.
Methods Two hundred and eight unilateral PFNFs (mean patient age: 9.0 ± 4.8 years) were included. Based on preoperative radiographs, the new classification system distinguished PFNFs without anterior or posterior translation (Type I), PFNFs with anterior (Type II) or posterior (Type III) translation, PFNFs with a comminuted medial or posterior column (Type IV), and subtrochanteric femoral fractures (SFFs; Type V). Radiographs were evaluated twice with an interval of two weeks by 19 raters with different specialties, experiences and geographical origins. The results were compared with a selection of 50 patient age-matched unilateral PFNFs and SFFs (mean patient age: 9.1 ± 4.9 years). These were graded twice by the same graders according to the Delbet-Colonna (D-C) classification.
Results Four radiologists and 15 pediatric orthopedic surgeons from Europe and Asia graded the radiographs. Fair agreement was found between radiologists (κ = 0.296 ± 0.01) and surgeons (κ = 0.3 ± 0.005) (P = 0.17), although more experienced surgeons performed better than less experienced ones; a similar fair assessment was found for raters from Europe (κ = 0.309 ± 0.021) and Asia (κ = 0.3 ± 0.006) and for type II, III and IV fractures; the κ value in the first evaluation (0.309) was similar to that in the second evaluation (0.298). The overall κ value of the D-C classification subtypes was significantly higher (0.599 ± 0.217) than that of the new classification, 0.326 ± 0.162 (t = 3.190 P = 0.005).
Conclusions The new classification system showed fair reliability relative to the D-C classification. The reliability of the new classification system was not affected by the specialty or geographic origin of the rater or the evaluation round, only by rater experience level. The concordance was worse for PFNFs with anterior or posterior translation or with a comminuted medial or posterior columns.Purpose: The purpose of this study was to introduce a new classification system for paediatric femoral neck fractures (PFNFs) and to evaluate its reliability. Methods: Two hundred and eight unilateral PFNFs (mean patient age: 9.0 ± 4.8 years) were included. Based on preoperative radiographs, the new classification system distinguished PFNFs without anterior or posterior translation (Type I), PFNFs with anterior (Type II) or posterior (Type III) translation, PFNFs with a comminuted medial or posterior column (Type IV), and subtrochanteric femoral fractures (SFFs; Type V). Radiographs were evaluated twice with an interval of two weeks by 19 raters with different specialties, experiences and geographical origins. The results were compared with a selection of 50 patient age-matched unilateral PFNFs and SFFs (mean patient age: 9.1 ± 4.9 years). These were graded twice by the same graders according to the Delbet-Colonna (D-C) classification. Results: Four radiologists and 15 paediatric orthopaedic surgeons from Europe and Asia graded the radiographs. Fair agreement was found between radiologists (κ = 0.296 ± 0.01) and surgeons (κ = 0.3 ± 0.005) (P = 0.17), although more experienced surgeons performed better than less experienced ones; a similar fair assessment was found for raters from Europe (κ = 0.309 ± 0.021) and Asia (κ = 0.3 ± 0.006) and for type II, III and IV fractures; the κ value in the first evaluation (0.309) was similar to that in the second evaluation (0.298). The overall κ value of the D-C classification subtypes was significantly higher (0.599 ± 0.217) than that of the new classification, 0.326 ± 0.162 (t = 3.190 P = 0.005). Conclusions: The new classification system showed fair reliability relative to the D-C classification. The reliability of the new classification system was not affected by the specialty or geographic origin of the rater or the evaluation round, only by rater experience level. The concordance was worse for PFNFs with anterior or posterior translation or with a comminuted medial or posterior columns
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