This descriptive clinical case series analyzes five cases of destructive thyrotoxicosis associated with Hashimoto's thyroiditis, historically referred to as hashitoxicosis, initially misdiagnosed as Graves' disease, highlighting a persistent diagnostic challenge in autoimmune thyroid disorders. The series includes four published cases reported between 2000 and 2025 and one unpublished case contributed by the authors. The cohort comprised three females and two males, with a mean age of 55.4 years (range: 21-69). Clinical presentations were heterogeneous, most commonly fatigue (80%), palpitations (60%), and weight changes (40%), while two patients exhibited no overt hyperthyroid symptoms.Biochemical evaluation demonstrated suppressed thyroid-stimulating hormone (TSH) levels in all cases (range: <0.000-0.13 µIU/mL), elevated anti-thyroid peroxidase (anti-TPO) antibodies in 80% (range: 41->1,000 IU/mL), and initially negative thyroid-stimulating hormone receptor antibodies (TRAb/TSI) in 60% of patients. Seroconversion to positive TRAb/TSI was observed in two cases during follow-up, suggesting autoimmune overlap rather than definitive disease transition. Imaging findings, including thyroid ultrasonography and radioiodine uptake (RAI) studies, consistently favored destructive thyroiditis over stimulatory hyperthyroidism, with heterogeneous echotexture observed in 75% of assessed cases and low or normal RAI uptake in all evaluated patients.Misdiagnosis occurred in 80% of cases, predominantly due to reliance on suppressed TSH levels without TRAb confirmation, resulting in inappropriate antithyroid drug administration in 80% and accelerated hypothyroidism in 60%. Immunopathological interpretation based on existing literature supports a predominantly Th1-mediated destructive process, in contrast to the Th2-driven antibody-mediated stimulation characteristic of Graves' disease, with rare Th1-to-Th2 immune shifts reported. Clinical outcomes ranged from spontaneous resolution to surgical intervention.This case series underscores the importance of mandatory TRAb testing, adherence to American and European Thyroid Association guidelines, and early specialist referral to reduce iatrogenic harm and improve diagnostic precision in autoimmune thyroid disease.
Acetabular fractures with cartilage impaction are associated with a high risk of post-traumatic osteoarthritis, frequently requiring total hip arthroplasty (THA). Conventional open reduction and internal fixation (ORIF) often fail to restore joint surface congruity. This case series evaluates the radiological and clinical outcomes of a novel minimally invasive technique using balloon acetabuloplasty to reduce dome impaction in traumatic acetabular fractures. This retrospective case series included patients with acetabular fractures involving cartilage impaction. Balloon acetabuloplasty was indicated when the impaction was inaccessible through standard approaches or in isolated impaction cases suitable for percutaneous treatment. Step and gap were measured on pre- and postoperative CT scans (St. Joseph Acetabular Score). Secondary outcomes included conversion to THA and functional evaluation using the Simple Hip Value (SHV) at latest follow-up. Eight patients (mean age, 56 ± 8 years; 1 female, 7 males) were included. Mean follow-up was 22 ± 9 months (range, 9-31 months). Fracture types comprised three anterior column and posterior hemitransverse, one T-shaped fracture, one both-column, one transverse, one anterior wall and one posterior wall fracture. Four patients were treated using an open Stoppa approach and four with a percutaneous approach. The mean step was reduced from 8.6 to 0.7 mm (p = 0.014), and the gap from 3.5 to 1.0 mm (p = 0.021). Two patients (25%) required THA during follow-up. In the remaining six patients, mean Simple Hip Value (SHV) at latest follow-up was 92 ± 8%. No complications were reported. Balloon acetabuloplasty is a promising minimally invasive technique to address dome impaction in acetabular fractures. It may improve articular surface restoration and reduce the risk of progression to THA. Further studies are needed.
Twin pregnancies are associated with higher perinatal mortality and morbidity. The assessment of fetal growth in these pregnancies using singleton or twin charts remains controversial. The aim of this study was to evaluate the impact of the implementation of twin-specific growth charts on adverse perinatal outcomes in twin pregnancies. This is a retrospective cohort study of twin pregnancies delivered at St George's University Hospitals (2000-2023). Twin-specific growth charts were implemented in July 2017; 2020 was excluded due to COVID-19-related confounding. Pregnancies with both fetuses alive at ≥23+6 weeks were included, excluding cases with anomalies, monoamniotic twins, twin-to-twin transfusion syndrome, termination, or incomplete data. Pre- (2000-June 2017) and post-intervention (July 2017-2023) periods were compared. Outcomes included small-for-gestational age (SGA), fetal growth restriction (FGR), preterm birth (<37 weeks), late preterm birth (34-36+6 weeks), iatrogenic preterm birth, stillbirth, and neonatal unit admission. Interrupted time series (ITS) analysis with segmented regression of semiannual data assessed immediate and trend changes following implementation. 2008 twin pregnancies were analysed, including 1533 in the pre-intervention and 475 in the post-intervention period. Following implementation, the rates of SGA and FGR diagnoses per fetus decreased substantially (SGA: 53.2% vs. 11.0%; FGR: 47.1% vs. 6.8%; both p < 0.001). ITS analysis demonstrated immediate reductions in FGR (-40.0%, p < 0.001) and SGA (-42.8%, p < 0.001) diagnoses following the policy change, with no significant change in trend. Iatrogenic preterm birth showed a significant immediate reduction (-13.6%, p = 0.016), although without a sustained trend. No intervention effects were identified for stillbirth or neonatal unit admission rates (p > 0.05 for both). Use of twin-specific charts for antenatal growth surveillance was associated with fewer diagnoses of SGA and FGR and an immediate, but not sustained, reduction in iatrogenic preterm birth. No worsening was observed in the adverse perinatal outcomes assessed, including stillbirth and neonatal unit admission.
In mesial temporal lobe epilepsy, resection or ablation-typically of anterior temporal structures-is highly successful in achieving seizure freedom. However, in a substantial proportion of patients, seizures recur for unclear reasons. Invasive hippocampal recordings suggest that, in some patients, hippocampal seizures are highly focal, often restricted to the anterior or posterior hippocampus. This led us to hypothesize that resection or ablation limited to the hippocampal subregion(s) involved at seizure onset is more likely to control seizures than surgery that does not address the specific onset locations. We present a case in which seizures were successfully controlled after posterior hippocampal ablation, as well as a retrospective case series of 18 patients in which 10 cases demonstrated focal onsets within the anterior or posterior hippocampus. Better outcomes occurred when surgery was concordant with the onset region(s) versus discordant (n = 7 concordant vs. 11 discordant patients, P = 0.046, Barnard Exact test). These data suggest that mesial temporal lobe epilepsy can be subdivided according to whether the hippocampal onset pattern is focal or nonfocal, and that targeting localized seizure onset zones within the hippocampus can be effective for seizure control, while limiting surgical morbidity and potentially the risk of adverse cognitive outcomes.
To describe the perioperative, oncologic, and structural outcomes of unilateral hemilaminectomy for pediatric intradural spinal tumors. We retrospectively reviewed all children aged ≤ 16 years who underwent unilateral hemilaminectomy for an intradural spinal tumor at a single tertiary center between 2018 and 2023. Clinical records, operative data, early postoperative contrast-enhanced MRI, and subsequent surveillance imaging were evaluated. Primary outcomes were 30-day complications and clinically detected postoperative deformity or instability requiring further evaluation or treatment. Among 246 spinal tumor operations across all age groups, 11 involved children; six extradural tumors were excluded, and all five pediatric intradural tumors underwent unilateral hemilaminectomy. Four patients were aged 13-16 years. Early postoperative MRI demonstrated gross-total resection in three patients, near-total resection in one, and subtotal resection in one. In the latter patient, a greater than 80% reduction in motor-evoked potential amplitude prompted termination of the index procedure without tumor resection. An unplanned second operation was performed 7 days later, but similar monitoring deterioration limited resection to subtotal removal. The child experienced transient quadriparesis after both procedures; both episodes resolved before discharge. Stereotactic radiotherapy was subsequently administered. During a median follow-up of 26 months (range, 18-84 months), no tumor-related reoperation or clinically detected deformity or instability requiring bracing, referral, or fusion was documented. Unilateral hemilaminectomy provided surgical access for pediatric intradural tumors while preserving the contralateral posterior elements. However, the small, predominantly adolescent cohort, absence of systematic standing radiographs, and limited follow-up preclude conclusions regarding subtle or late deformity or comparative superiority.
Hepatitis B virus (HBV) genotype E, mainly found in sub-Saharan Africa, exhibits low genetic diversity, unique molecular markers and high recombination potential but remains under-studied. This study describes the clinical and virological characteristics, mutational profiles, antiviral treatment responses and phylogenetic data of patients with confirmed HBV genotype E infection in a tertiary-care centre in northern Italy. A retrospective monocentric study was conducted at ASST Spedali Civili di Brescia, Italy, from 2015 to 2023. Patients with documented HBV genotype E who underwent genotypic resistance testing (GRT) for clinical reasons were included. Direct sequencing of the S/POL region was used for genotyping and mutation analysis, interpreted via Geno2pheno [hbv] 2.0 and Stanford HBV resistance tools. Eight patients were identified, mostly male (62.5%) and of African origin (87.5%), with a median age of 38.5 years. GRT was performed in six (75%) patients because of persistent viremia despite antiviral treatment, five (83.3%) of whom were HIV/HBV coinfected with detectable HIV viral load. Lamivudine resistance mutations (L180M, M204V) were found in one (12.5%) case, tenofovir resistance-associated mutations (M267L/I) in two (25%) and immune escape mutations in three (37.5%), including T126I, D144E and G145R. Despite GRT, treatment was not modified in four (50%) patients due to poor adherence concerns. Therapy adjustments led to viral suppression in three (37.5%) cases. In our setting, HBV genotype E infections largely occurred among migrants from endemic regions. Although nucleos(t)ide analogues are effective across genotypes, suboptimal adherence may hinder viral suppression and promote resistance.
The authors aimed to evaluate the feasibility/safety of stereo-electroencephalography (SEEG) and SEEG-guided radiofrequency thermocoagulation (RFTC) in patients with drug-resistant epilepsy previously implanted with neuromodulation devices, using a retrospective cohort design evaluating patients treated at the Mayo Clinic Florida Epilepsy Center. Nine patients (mean age 36.3 ± 10.9 years, 33% female) with prior implantation of neuromodulation devices were included. A vagus nerve stimulator was present in 8 of 9 patients, and 4 patients had undergone previous intracranial neuromodulation. Five patients underwent SEEG-RFTC. The mean SEEG monitoring duration was 6.5 ± 2.9 days. No intraoperative or procedural complications occurred, including hardware-related issues. No permanent or significant neurological/cognitive deficits occurred. One patient experienced transient postoperative neurological symptoms attributed to perilesional edema. Seizure reduction ranged from 50% to 75% following SEEG-RFTC. SEEG and SEEG-RFTC are feasible in patients who have implanted neuromodulation devices, including intracranial implants. These procedures may be performed without interference with existing hardware and provide meaningful seizure reduction in highly refractory populations. Further studies with larger cohorts and longer follow-up are needed to better define efficacy and patient selection. https://thejns.org/doi/10.3171/CASE26376.
We aimed to describe a few rare differential diagnoses of primary empty sella by reporting clinical and magnetic resonance imaging (MRI) findings that can potentially mislead the diagnosis. The study included patients with intrasellar arachnoid cyst, pituitary stalk interruption syndrome, spontaneous transsellar meningoceles extending to the sphenoid sinus, intrasellar Rathke cleft cyst, and pituitary adenoma with cystic degeneration. Differentiation from primary empty sella was possible based on the pituitary morphology and location, pituitary stalk configuration, sellar floor integrity, extension to the sphenoid sinus, and MRI signal characteristics. Cerebrospinal fluid-equivalent signal intensity without enhancement was observed in the intrasellar arachnoid cyst. Pituitary stalk interruption syndrome was characterized by absent or interrupted stalk with an ectopic posterior pituitary. Spontaneous transsellar meningoceles extending to the sphenoid sinus demonstrated herniation of cerebrospinal fluid-containing meninges through sellar defects. Rathke's cleft cyst may simulate partial empty sella, however, the presence of a midline cyst and occasionally an intracystic nodule helps establish the diagnosis. Cystic degeneration in pituitary adenomas may mimic empty sella appearance, but asymmetric elevation of the diaphragma sellae, deviation of the pituitary stalk, and subtle peripheral enhancement of residual tumor tissue can provide important diagnostic clues. A structured MRI evaluation focusing on pituitary anatomy, stalk configuration, sellar floor integrity, sphenoid sinus pathology, and subtle cystic lesions characteristics can reliably differentiate true primary empty sella from its rare mimics.
Texture classification requires characterizing spatial arrangements of pixel intensities, such as periodicity, directionality, and surface roughness. This task is critical across diverse domains, including remote sensing, materials science, and biomedical imaging. In this paper, we propose a two-step information-theoretic framework for texture discrimination. First, each image is transformed into a one-dimensional time series using a space-filling Hilbert curve. This approach preserves spatial locality while avoiding the introduction of a privileged scanning direction. Second, we extract a comprehensive set of eight complementary quantifiers from the resulting series: permutation entropy, statistical complexity, Fisher information (under both lexicographic and colexicographic orderings), Wasserstein distances between the ordinal-pattern distribution and the uniform distribution, weighted permutation entropy, and amplitude-aware permutation entropy. These scalar features are then used to train a support vector machine with a radial basis function kernel, utilizing nested cross-validation for hyperparameter optimization. We validate this framework on the Kylberg texture database, a benchmark consisting of 280 images across 28 classes. Our results demonstrate that while the classical complexity-entropy causality plane offers some discriminative power, amplitude-sensitive quantifiers (specifically weighted permutation entropy) are the primary drivers of performance. These findings underscore the necessity of encoding amplitude information alongside ordinal patterns for effective texture characterization.
This study aimed to evaluate the short- to mid-term clinical outcomes following arthroscopic extensor carpi radialis brevis (ECRB) debridement in patients with chronic epicondylopathy humeri radialis (cEHR). We hypothesized that arthroscopic ECRB debridement would result in favorable short- to mid-term patient-reported outcomes, improving pain levels, strength, range of motion (ROM) and patient satisfaction. A retrospective case series was conducted on patients who underwent arthroscopic ECRB debridement for cEHR with symptoms > 6 months. Patients were assessed at a minimum of 12 months postoperatively using the Mayo Elbow Performance Score (MEPS), Patient-Rated Tennis Elbow Evaluation (PRTEE), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Visual Analog Scale (VAS) for pain. Pre- and postoperative scores were compared using DASH and VAS. Maximum isometric wrist extension strength and postoperative ROM were measured bilaterally. Return to sport and work, patient satisfaction, and complications were documented. Of the 35 eligible patients, 30 completed follow-up (86% follow-up rate; mean age 48.4 ± 6.6 years; range: 36-65 years; 47% male). The mean duration of symptoms before surgery was 12 months (IQR 8-20, range 6-62). The mean follow-up duration was 28.13 ± 10.9 months (range 12-45). At final follow-up, median outcome scores were 100 (IQR 100-100; range 65-100) for the MEPS, 8.7 (IQR 0.8-13.9; range 0-39.2) for the DASH, 0 (IQR 0-1; range 0-7) for the VAS and 10.3 (IQR 0.8-26.8; 0-79.5) for the PRTEE. In comparison to preoperative values, VAS scores significantly improved (6 [IQR 2.75-7, range 9] vs. 0 [IQR 0-1, range 0-7], p < 0.01), as did DASH scores (46.6 ± 20 vs. 10.3 ± 10.5, p < 0.01). Post-operatively, all patients recovered full range of motion, with an arc of at least 140°. The median wrist extension strength in the operated arm was 98.6% (IQR: 87.4-107%, range: 69.5-121%) when compared to the healthy side, with no significant differences (p = 0.681). Overall, 80% of patients returned to sports at the same or a slightly reduced level, including 12% who achieved a higher activity level than before. The vast majority of patients (97%) successfully returned to their previous professional activities, while only a small proportion (3%) retired from a part-time manual labor position post-surgery, primarily due to age. Furthermore, 83% of patients indicated they would undergo the procedure again. One patient developed posterolateral rotational instability six months after index surgery and consequently required reconstruction of the lateral ulnar collateral ligament (LUCL). Arthroscopic ECRB debridement for cEHR was associated with improved pain and function and high rates of return to sport and work at short- to mid-term follow-up. IV Retrospective case series.
This work investigates the interaction of anionic borate clusters with self-assembled surfactant systems. Anionic borate clusters, such as closo-dodecaborates B12X122- (X = H, Cl, Br, I) and cobaltabisdicarbollide (COSAN-), bind hydrated solutes via a water-mediated (super)chaotropic effect. Cloud point measurements on the micellar phase of the nonionic surfactant C8E4 reveal a continuous series of binding affinity from chaotropic (B12H122-) over superchaotropic (B12Cl122-, B12Br122-) to hydrophobic ions (B12I122-, COSAN), extending seamlessly the Hofmeister series of classical ions and in line with data for ten additional nanometer-sized ions gleaned from the literature. Small-angle X-ray and neutron scattering revealed a structural criterion distinguishing superchaotropic from hydrophobic ions. Superchaotropic ions form a saturated interfacial monolayer between surfactant headgroups. Hydrophobic ions, however, localize in the apolar interior of the micelle, causing a curvature transition into bilayer structures in C8E4, a surfactant system that does not form bilayers on its own, leading to micellar destabilization and phase separation at higher concentrations.
Robotic extended-view totally extraperitoneal (eTEP) ventral hernia repair has emerged as a preferred approach to minimally invasive abdominal wall reconstruction. Herein, we report outcomes of the largest series of eTEP to date, including greater than 2-year follow-up. We performed a retrospective review of all consecutive patients undergoing robotic eTEP hernia repair at a single institution. Data were collected in the Abdominal Core Health Quality Collaborative (ACHQC) with additional chart review to capture long-term follow-up, operative time, and eTEP approach. Descriptive analysis of patient demographics, operative details, perioperative, and postoperative outcomes are provided, along with Kaplan-Meier analysis for hernia recurrence. A total of 380 repairs were performed with a 2 conversions to open repair. Incisional hernias accounted for 94.5% of cases, including 31.8% recurrent defects, with a mean hernia width 7.6 ± 3.8 cm. One-hundred fifteen (30.2%) of cases required additional lateral myofascial release, and fascial closure was achieved in 99.5% of cases. Rate of surgical site infection (SSI) was 1.6%, surgical site occurrence (SSO) was 48.7% (93% of which were seromas), LOS of 1 day, and 2-year rate of hernia recurrence of just 4.4%. Robotic eTEP ventral hernia repair exhibits favorable outcomes with a short length of stay, low rate of surgical site infection, and a promisingly low rate of hernia recurrence at 2 years.
Supramolecular metallogels based on platinum(II) complexes have attracted growing interest due to their tunable photophysical properties. However, the potential of Pt(II)-salphen complexes as low-molecular-weight gelators remains largely unexplored. Here, we report a series of Pt(II)-salphen complexes bearing alkyl chains of varying lengths and their organogelation properties. The complexes with the longer chain gelled aromatic solvents, forming hierarchical fibrillar networks, whose mechanical strength scales with alkyl chain length. Multi-scale analysis by cryo-TEM, SAXS, rheology, XRD, and solid-state NMR revealed the contributions of Pt-Pt metallophilic interactions alongside π-π stacking in the formation of the fibrils. This work opens a new avenue for tailored luminescent soft materials.
Mycosis fungoides (MF) is a cutaneous T-cell lymphoma that typically progresses slowly and has a favorable initial prognosis; however, the clinical course worsens in advanced stages. The aim of this study was to investigate the levels of programmed death-1 (PD-1), PD-L1, and PD-L2 immunoexpression in the biopsies of patients with MF. Paraffin blocks from biopsies of 82 patients diagnosed with MF between 2019 and 2025 were selected for this study. Early-phase (initial) and later-phase lesion groups, as well as CD4-positive and CD8-positive disease groups were formed based on histological findings. Immunohistochemical staining was performed for PD-1, PD-L1, and PD-L2. Positivity scores were generated for tumor cells, cells in the tumor microenvironment, and combined positivity scores. Immune scores were statistically compared across the lesion phase, CD4‑CD8 positivity status, age, and sex. Of the patients, 56 (68%) had later-phase lesions, 26 (32%) had early-phase lesions, 64 (78%) were CD4-positive, and 18 (22%) were CD8-positive. PD-1, PD-L1, and PD-L2 expression levels are higher in later-phase lesions than in early-phase lesions. The effect size was found to be small to moderate. CD4 or CD8 positivity, age, and sex did not affect PD-1, PD-L1, or PD-L2 levels. Immune checkpoint inhibitors could be beneficial in the management of MF, a disease that is difficult to treat in the advanced stages. Studies with larger patient series, in which evaluation can be performed alongside clinical staging, are needed.
Diced cartilage is widely used for dorsal nasal augmentation, but its fluid consistency may predispose to migration, contour irregularity, and handling difficulties. We describe a preliminary technical feasibility experience using autologous platelet-rich plasma (PRP) combined with diced cartilage and semi-dried with controlled warm airflow to create a cohesive, moldable graft for dorsal and radix augmentation. Septal cartilage was diced into 0.5-1-mm fragments and mixed dropwise with liquid PRP prepared using the Silfradent MEDIFUGE CGF system. The mixture was spread on a sterile surface and exposed to controlled warm airflow for 3-5 minutes, with the graft surface temperature maintained at or below 45 °C, until a semi-solid consistency was achieved. The resulting graft was inserted into the dorsal and radix pocket without fascia wrapping, sutures, or fibrin adhesives. The technique was applied in two primary rhinoplasty cases and one revision rhinoplasty case. All three patients were evaluated clinically and photographically at 1 month and 6 months postoperatively. During the observed short- to mid-term follow-up, the graft demonstrated satisfactory intraoperative handling and clinically maintained dorsal contour, with no clinically evident migration, infection, contour irregularity, or overlying skin thinning. This clinical maintenance of dorsal contour was observed in both primary and revision cases, including patients with thin and very thick skin. These findings are based on clinical examination and standardized photographic assessment only. Semi-dried PRP-stabilized diced cartilage may represent a simple, low-cost, and foreign-material-free option for dorsal augmentation in selected patients. In this preliminary technical feasibility series, the technique provided cohesive intraoperative handling and clinically satisfactory short- to mid-term contour maintenance without wrapping or adhesive fixation. Long-term stability, volume preservation, and biological effects remain unproven and require objective validation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Major depressive disorder is associated with cognitive deficits, yet the specific impact of recurrence remains unclear. This systematic review and meta-analysis compared cognitive performance between individuals with first-episode depression (FED) and recurrent major depressive disorder (rMDD). Five databases were searched to identify eligible studies. A series of meta-analyses for each cognitive domain were conducted with inverse-variance, random-effects modeling. Demographic and clinical moderators were explored, with leave-one-out sensitivity analyses. Twenty-four eligible studies were included in the review, of which data from 2,487 participants (k = 20; FEDn = 1,288, rMDDn = 1,199) contributed to meta-analyses. Relative to FED, rMDD showed statistically significant small to moderate effects indicative of poorer performance across several cognitive domains: processing speed (g = -0.20), auditory attention (g = -0.33), working memory (g = -0.47), verbal learning (g = -0.41), and verbal memory (g = -0.54), albeit the size of effect was found to vary dependent on the neuropsychological test or outcome measure. Over half the analyses resulted in nonsignificant differences in cognitive performance in rMDD versus FED. Findings remained relatively robust to leave-one-out analyses. No demographic or clinical variables reliably moderated effects. Scarring effects of episode recurrence appear to impact a select few cognitive domains. To further advance understanding of cognitive heterogeneity across illness stages and to inform targeted interventions to mitigate possible worsening of cognitive function and relapse risk, longitudinal cognitive tracking is needed to elucidate when and under what circumstances recurrent episodes may exacerbate cognition. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Molecular testing has become a cornerstone in pediatric neuro-oncology but relies on time intensive workflows at specialized centers. We hypothesized that time to adjuvant therapy has increased since the incorporation of molecular testing. In this retrospective case series, data were collected from Riley Hospital for Children in Indianapolis from the pre-molecular era (2007-2009) and the molecular era (2023-2025). Patients aged ≤ 21 years who received initial surgery for a primary brain tumor were included. The primary outcome of interest was the time from initial surgery to initiation of adjuvant treatment. A total of 140 patients met inclusion criteria, including 83 who received adjuvant therapy as part of the initial postoperative treatment plan. Time to adjuvant treatment was significantly shorter in the pre-molecular cohort (24.5 vs 34.2 days). Multivariate analysis demonstrated that this prolonged time to treatment was associated with the use of targeted therapies that rely on molecular testing for diagnosis, and increased patient referrals to external institutions during the molecular era. The most cited reasons for delay in adjuvant treatment were final pathology report pending, family decision making, and shunt-related factors. Time to adjuvant therapy was longer in the molecular era, and this effect was attributable to evolving treatment paradigms, specifically the adoption of targeted therapies related to molecular diagnosis and increased reliance on external treatment centers. These results underscore modifiable, system-level barriers in the delivery of precision oncology which represent key opportunities to improve timeliness of care and, ultimately, patient outcomes.
Anterior cruciate ligament (ACL) reconstruction in adolescents is associated with higher graft failure rates than in adults. Lateral extra-articular tenodesis (LET) may improve rotational stability and potentially reduce graft failure in this high-risk population. This study aimed to evaluate functional outcomes, return to sport (RTS), graft failure, and reintervention rates in adolescents undergoing ACL reconstruction combined with modified Lemaire LET. This prospective single-center cohort included patients younger than 18 years who underwent primary ACL reconstruction using hamstring autograft combined with modified Lemaire LET and had a minimum follow-up of 12 months. Outcomes included the Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Form, RTS rate and timing, graft failure, and reinterventions. Fifty-five patients were included, with a median age of 16.8 years (IQR, 16.1-17.6); 36 patients were male (65.5%). The mean follow-up was 28.7 months (range, 12-36 months). At final follow-up, the median Lysholm score was 94.0 (IQR, 89.5-96.0), and the median subjective IKDC score was 85.0 (IQR, 80.0-89.0). RTS was achieved in 53 patients (96.4%) at a median of 12.0 months after surgery (IQR, 11.8-13.0). Graft failure occurred in five patients (9.1%) at a median of 17.0 months postoperatively (IQR, 15.0-17.0), and nine patients (16.4%) underwent ipsilateral knee reintervention during follow-up, including revision ACL reconstruction and additional meniscal or lateral extra-articular procedures. In this prospective cohort of adolescents undergoing ACL reconstruction combined with modified Lemaire lateral extra-articular tenodesis, short-term subjective knee function was favorable, return to organized sport occurred in 96.4% of patients, and graft failure occurred in 9.1%. Level IV, therapeutic case series.
Acetabular retroversion is a distinct morphologic variation that may result in pincer-type femoroacetabular impingement (FAI). The role of arthroscopic management within this cohort is not fully understood. To assess patient-reported outcome measures (PROMs) and survivorship at 5-year follow-up in a series of cases undergoing arthroscopic correction of pincer-type FAI with acetabular retroversion. Cohort study; Level of evidence, 3. A single-center, prospective hip preservation registry was reviewed for all cases undergoing primary hip arthroscopy for symptomatic FAI between January 2014 and July 2020, with documented radiographic assessment of acetabular retroversion (ie, presence or absence of crossover sign, ischial spine sign, and/or posterior wall sign on a standing, standardized anteroposterior radiograph). Exclusion criteria were Tönnis grade >1, concomitant pathologies (protrusio, Perthes disease, avascular necrosis), excessive pelvic rotation or tilt on radiographs, and/or no crossover sign. Cases were assigned to 1 of 2 groups: moderate-global retroversion group (study group: crossover sign plus either or both ischial spine sign and posterior wall sign) or control group (crossover sign only). Case-control (1:1) fuzzy matching was performed based on age (±2 years), sex, and Tönnis grade (exact). Clinical outcome evaluation included assessment of PROMs (modified Harris Hip Score [mHHS], 36-item Short Form [SF36], University of California-Los Angeles Activity Scale [UCLA], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), achievement of Patient Acceptable Symptom State (PASS), satisfaction, rates of revision arthroscopy, and arthroplasty-free survivorship, both preoperatively and 5 years postoperatively. Statistical analysis was performed using SPSS v29. A total of 201 cases (120 global, 81 moderate) in the moderate-global retroversion group were matched with 201 control cases. Mean age was 30.6 ± 10.2 years; the sample was 90% male. The rate of revision arthroscopy was similar: n = 11 (6%) in both groups (P = .974). No conversion to periacetabular osteotomy (PAO) occurred in either group. Arthroplasty-free survivorship was 98.2% (retroversion group) and 98.8% (control group) (χ2 = 0.189; df = 1; P = .664). Significant improvements in PROMs from baseline were noted (P < .001 for all, in both groups). In total, 81% (moderate-global retroversion group) and 73% (control group) were satisfied at 5 years (P = .103). No significant difference was seen in PASS achievement rates for any of the PROMs between groups: mHHS, 62.1% versus 65.9% (P = .498); UCLA, 60.0% versus 52.2% (P = .192); SF36, 59.8% versus 64.7% (P = .458); WOMAC, 63.5% versus 67.3% (P = .553), for moderate-global retroversion and control groups, respectively. Hip arthroscopy for moderate and global acetabular retroversion resulted in significant improvement in clinical outcomes, with high satisfaction and arthroplasty-free survivorship at 5 years, consistent with a case-control matched group without acetabular retroversion (focal retroversion, pincer FAI). Arthroscopy alone, without anteverting PAO, was an effective surgical management approach for symptomatic FAI in the presence of acetabular retroversion.
Five heteroleptic iridium(III) complexes bearing cyclometalated 2,4-diphenylpyridinato ligands and a 4,4'-dimethyl-2,2'-bipyridine ancillary ligand were synthesized. Modulation of substituents at the 4'-position of the cyclometalated phenyl ring provided systematic variation in oxidation potentials, emission wavelengths, and luminescence quantum yields, used herein to interrogate the relationship between electronic structure and electrochemiluminescence (ECL) response. With tri-n-propylamine as co-reactant, the relative ECL intensities of the complexes depended strongly on the excitation pathway, for which distinct optima in co-reactant concentration were also identified. The complexes bearing more electron-withdrawing substituents exhibited the greatest ECL intensities via the reductive excitation (direct) pathway, but rendered the oxidative excitation (indirect) pathway energetically inaccessible. Under cathodic potentials with benzoyl peroxide as co-reactant, the unsubstituted complex exhibited the highest ECL intensities within the series, exceeding those of [Ru(bpy)3]2+ under selected conditions. These findings highlight that ECL performance is governed by luminescence efficiency, the excitation pathway and energetic alignment with the co-reactant system, and that even subtle changes in luminophore properties can have multiple, sometimes competing, effects on ECL intensity.