Association between obstructive sleep apnea and floppy eyelid syndrome: A systematic review and metaanalysis

RationaleObstructive sleep apnoea (OSA) has been linked to various ocular disorders, including floppy eyelid syndrome (FES). Previous studies have hypothesised the underlying association between the 2 , but results are currently still inconclusive.ObjectiveTo investigate the association between OSA and FES.MethodsFour databases (Pubmed, Embase, Scopus, and Cochrane Library) were searched from inception until 28 February 2022 for observational studies and randomized controlled trials assessing the association between OSA and FES. Two reviewers selected studies, extracted data, graded the risk of bias using the Newcastle-Ottawa scale and the quality of assessment using the Grading of Recommendations Assessment, Development, and Evaluation system. Random-effects models were used to metaanalyze the associations.ResultsTwelve studies were included in the systematic review, of which nine were suitable for metaanalysis, with a combined cohort of 1,109 patients. Risk of bias was low to moderate. The overall analysis showed a significant positive association between OSA and FES (OR = 1.89, 95% CI = 1.27–2.83, I 2 = 44%). Further analysis revealed that the more severe the OSA was, the higher the risk of developing FES. Patients with severe OSA had the nominally highest risk of developing FES (OR = 3.06, 95% CI = 1.62–5.78, I 2 = 0%), followed by moderate OSA (OR = 2.53, 95% CI = 1.29–4.97, I 2 = 0%), and patients with mild OSA had the lowest risk (OR = 1.76, 95% CI = 0.85–3.62, I 2 = 0%).ConclusionOur metaanalysis reports a positive association between OSA and FES, with increasing severity of OSA correlating with a significantly higher risk of FES. More longitudinal studies with sufficient duration of follow-up are needed to better characterise the relationship between OSA and FES.     

Differentiating autoimmune pancreatitis from pancreatic ductal adenocarcinoma with CT radiomics features

PurposeThe purpose of this study was to determine whether computed tomography (CT)-based machine learning of radiomics features could help distinguish autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC).Materials and MethodsEighty-nine patients with AIP (65 men, 24 women; mean age, 59.7 ± 13.9 [SD] years; range: 21–83 years) and 93 patients with PDAC (68 men, 25 women; mean age, 60.1 ± 12.3 [SD] years; range: 36–86 years) were retrospectively included. All patients had dedicated dual-phase pancreatic protocol CT between 2004 and 2018. Thin-slice images (0.75/0.5 mm thickness/increment) were compared with thick-slices images (3 or 5 mm thickness/increment). Pancreatic regions involved by PDAC or AIP (areas of enlargement, altered enhancement, effacement of pancreatic duct) as well as uninvolved parenchyma were segmented as three-dimensional volumes. Four hundred and thirty-one radiomics features were extracted and a random forest was used to distinguish AIP from PDAC. CT data of 60 AIP and 60 PDAC patients were used for training and those of 29 AIP and 33 PDAC independent patients were used for testing.ResultsThe pancreas was diffusely involved in 37 (37/89; 41.6%) patients with AIP and not diffusely in 52 (52/89; 58.4%) patients. Using machine learning, 95.2% (59/62; 95% confidence interval [CI]: 89.8–100%), 83.9% (52:67; 95% CI: 74.7–93.0%) and 77.4% (48/62; 95% CI: 67.0–87.8%) of the 62 test patients were correctly classified as either having PDAC or AIP with thin-slice venous phase, thin-slice arterial phase, and thick-slice venous phase CT, respectively. Three of the 29 patients with AIP (3/29; 10.3%) were incorrectly classified as having PDAC but all 33 patients with PDAC (33/33; 100%) were correctly classified with thin-slice venous phase with 89.7% sensitivity (26/29; 95% CI: 78.6–100%) and 100% specificity (33/33; 95% CI: 93–100%) for the diagnosis of AIP, 95.2% accuracy (59/62; 95% CI: 89.8–100%) and area under the curve of 0.975 (95% CI: 0.936–1.0).ConclusionsRadiomic features help differentiate AIP from PDAC with an overall accuracy of 95.2%.     

Ⅰ期前后路联合手术治疗严重下颈椎骨折脱位

[目的]探讨Ⅰ期前后路联合手术固定在严重下颈椎骨折脱位中的临床疗效和应用价值。[方法]采用颈椎前路钢板和后路侧块钉棒Ⅰ期联合复位内固定技术治疗严重下颈椎骨折脱位27例,手术均在颅骨牵引下经鼻腔气管插管全身麻醉下进行,先采用俯卧位,植入侧块螺钉、减压、复位后,植入棒,运用“弓弦原理”,采用CD旋棒技术恢复颈椎的序列,维持并稍加大颈椎在矢状面上的生理前凸,植骨融合后拆除颅骨牵引置仰卧位,行前路椎体复位、减压、植骨及自锁钛板固定。术后定期复查X线片以观察损伤节段的稳定性和融合率,以Frankel分级判定脊髓功能的恢复情况。[结果]术后27例全部获得随访,随访6~27个月,平均11.6个月。脱位均完全复位,无植骨不融合。损伤节段稳定,颈椎椎间高度及生理曲度都得到良好重建及维持,未出现内固定断裂、松动及脱出,无血管、神经、食道损伤等并发症。除5例A级、2例B级脊髓功能无恢复,Frankel分级无变化外,其余Frankel分级平均提高1.8级,其中5例患者达到E级。[结论]颈椎Ⅰ期前后路联合手术固定治疗严重下颈椎骨折脱位,完全恢复颈椎序列,复位良好,椎管前后方压迫得到彻底解除,损伤节段术后获得即刻稳定,方便术后护理和功能锻炼,有利于脊髓功能恢复,为一积极有效的方法。     

双极射频电热固缩治疗前交叉韧带松弛临床研究

目的:对15例前交叉韧带双极射频电热固缩治疗进行回顾性研究,评估其临床疗效。方法:从2000年1月至2005年1月采用双极射频对16例前交叉韧带松弛的患者进行电热固缩治疗。完整随访者15例,男性11例,女性4例,平均年龄29岁。12例前交叉韧带部分损伤,3例为自体绳肌重建术后。电热射频设备输出功率为284W,组织内作用温度为65℃。术后患者采用支具制动,康复计划与前交叉韧带重建术后基本相同。结果:随访时间平均15·6个月(4~25个月)。Lysholm评分,术前74·27±5·51分(66~84分),术后3个月89·6±7·11分(72~99分),两者相比有显著性差异(P<0·01);术后最终评分83·33±11·81分(56~95分),虽仍显著高于术前评分(P<0·05),但与术后3个月比较有所降低。KT-1000测量结果,术前两侧胫骨前移差值为5·47mm±1·61mm(3·5mm~10mm),术后3个月为2·67mm±1·35mm(2~7mm),与术前测量值对比存在显著性差异(P<0·01);最终测量结果为3·8mm±1·96mm(2~9mm),虽仍显著低于术前测量值(P<0·05),但较术后3个月有所增加。所有患者均未出现明显的术后并发症。2例患者(13·3%)术后失效,接受了二期重建手术。结论:电热固缩治疗前交叉韧带松弛可获得较好的短期主、客观疗效,但长期随访疗效有所下降。建议慎重选择手术适应症。     

Posterior instability near extension is related to clinical disability in isolated posterior cruciate ligament deficient patients

The purpose of this study is to evaluate the relationship between the magnitude of knee laxity and posterior instability at different knee flexion angles and clinical disability in isolated posterior cruciate ligament (PCL) deficient patients. Knee laxity at 20° and 70° of knee flexion were evaluated using KT-2000 arthrometer, and the posterior instability at 20°, 45° and 90° of flexion were evaluated using stress radiography. We assessed the differences in the knee laxity and the tibial translation between isolated PCL deficient knees and normal knees, and between the patients with giving-way during activities of daily living (ADL) and without giving-way. There were statistical differences in the knee laxity and the tibial translation at all knee flexion angles between the PCL deficient knees and normal knees. The magnitude of the knee laxity at 20° of flexion measured with KT-2000 arthrometer was significantly larger in the patients with giving-way than those in the patients without giving-way although there was no significant difference in the tibial translation at 70° between the two groups. The tibial translation in both medial and lateral compartments at 20° and 45° measured with stress radiography were significantly larger in the patients with giving-way than those in the patients without giving-way although there was not significant difference at 90° between the two groups. These results suggested that the magnitude of the knee laxity and the posterior tibial translation at shallow knee flexion angles would be related to giving-way during ADL in isolated PCL deficient patients.     

Does a tensioning device pinned to the tibia improve knee anterior–posterior load‐displacement compared to manual tensioning of the graft following anterior cruciate ligament reconstruction? A cadaveric study of two tibial fixation devices

Devices that are pinned to the tibia to tension an anterior cruciate ligament (ACL) graft produce joint reaction loads that in turn can affect the maintenance of graft initial tension after tibial fixation and hence knee anterior-posterior (AP) load-displacement. However, the effect of these devices on AP load-displacement is unknown. Our objectives were to determine whether tensioning by device versus tensioning by hand causes differences in AP load-displacement and intraarticular graft tension for two commonly used tibial fixation devices: a bioresorbable interference screw and a WasherLoc. AP load-displacement and intraarticular graft tension were measured in 20 cadaveric knees using a custom arthrometer. An initial tension of 110 N was applied to a double-looped tendon graft with the knee at extension using a tensioning device pinned to the tibia and a simulated method of tensioning by hand. After inserting the tibial fixation device, the 134 N anterior limit (i.e., anterior position of the tibia with respect to the femur with a 134 N anterior force applied to the tibia) and 0 N posterior limit (i.e., AP position of the tibia relative to the femur with a 0 N force applied to the tibia) were measured with the knee in 25 degrees flexion. Intraarticular graft tension was measured at extension. These limits and intraarticular graft tension were also measured after cyclically loading the knee 300 times. Compared to a simulated method of tensioning by hand, tensioning with a device pinned to the tibia did not decrease the 134 N anterior limit and did not cause posterior tibial translation. However, intraarticular graft tension was maintained better with a tensioning device pinned to the tibia for the Washerloc, but not the interference screw. For two commonly used tibial fixation devices, a tensioning device pinned to the tibia does not improve AP load-displacement at 25 degrees flexion over tensioning by hand when the graft is tensioned at full extension, but does improve the maintenance of intraarticular graft tension for the Washerloc.     

新式阴道前、后壁联合修补术临床分析

目的探讨新式阴道前、后壁联合修补术治疗盆腔脏器脱垂(POP)的临床效果。方法选择2017年1月至2021年1月,于南京医科大学附属淮安第一医院接受手术治疗的120例POP患者为研究对象。根据采用的手术方式,将其分为研究组(n=60,采用新式阴道前、后壁联合修补术)及对照组(n=60,采用腹腔镜下全子宫双侧附件切除术+传统阴道前、后壁修补术)。采用独立样本t检验及χ^(2)检验,对2组患者一般临床资料,术中及术后情况进行统计学比较。本研究经南京医科大学附属淮安第一医院医学伦理委员会批准(审批文号:YX-P-2020-023-01)。所有患者知情同意并与之签署临床研究知情同意书。结果①2组POP患者年龄、人体质量指数(BMI)、产次、绝经者比例及POP脱垂程度比较,差异均无统计学意义(P>0.05)。②研究组POP患者手术时间、术中出血量、总住院时间、术后住院时间及住院费用分别为(88.0±30.6)min、(24.7±36.0)mL、(7.3±2.1)d、(4.6±1.4)d及(10727±1812)元,均短于或低于对照组的(118.0±33.4)min、(56.7±43.8)mL、(9.8±2.3)d、(6.4±1.6)d及(26318±3890)元,并且差异均有统计学意义(t=5.130、4.372、6.218、6.558、28.138,均为P<0.001)。2组POP患者术后3、6、12个月复发率构成比比较,差异无统计学意义(P>0.05)。结论新式阴道前、后壁联合修补术在不增加POP患者术后复发率的基础上,不仅能缩短手术时间、减少患者术中出血量,还可以缩短住院时间、减少住院费用,并且易于操作,适宜推广。     

Efficacy of antibiotic‐impregnated cement in total hip replacement

Background and purpose?Antibiotic‐impregnated cement is used as a spacer or during re‐implantation surgery for the treatment of infected total hip arthroplasties. The routine use of antibiotic‐impregnated cement during primary or uninfected revision total hip arthroplasty remains controversial. With this meta‐analysis of the published literature, we intended to assess efficacy and safety in the use of antibiotic‐impregnated cement for uninfected arthroplasty.

Methods?Following a detailed literature search, only studies reporting on the outcome of total hip replacement performed with antibiotic cement were included. Strict inclusion criteria were used and studies lacking sufficient sample size or critical data were excluded. 19 studies reporting on 36,033 hip replacements in 35,659 patients met the initial inclusion criteria. The main aim of the meta‐analysis was to determine the rate of deep infection with and without the use of antibiotic cement, and to assess the revision rate and the ultimate survivorship of arthroplasty using antibiotic cement.

Results?The rate of deep infection following primary total hip arthroplasty, at 1.2%, was significantly lower when antibiotic cement was used than when cement without antibiotics was used (2.3%). Similarly, the rate of deep infection following revision total hip arthroplasty when a standard combination of cement and antibiotic—or a custom‐made combination of cement and antibiotic, depending on the results of culture—was used, was almost half of the rate of deep infection when no antibiotics were present in the cement. Overall, the survivorship was 98% (101 failures in 5,178 hips) for primary arthroplasty and 88% (100 failures in 855 hips) for revision arthroplasty. There were no reported adverse events or complications associated with the use of antibiotic‐impregnated cement.

Interpretation?The use of antibiotic‐impregnated cement lowered the infection rate by approximately 50% in primary hip arthroplasty. For revisions of previously infected hips, combinations or culture‐dependent antibiotics lowered infection rates by approximately 40%.