Medicine
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The effectiveness of a novel surgical approach for the treatment of congenital muscular torticollis.
The outcomes of surgical treatment for congenital muscular torticollis (CMT) are poor in many cases, primarily from surgeon's fear of damage to important blood vessels in the carotid sheath. The current research aimed to establish a novel, safer and more effective surgical approach for the treatment of CMT based on the anatomic relationship between the fascial sheath of the sternocleidomastoid muscle and the carotid sheath. A total of 12 formalin-fixed cadaveric specimens (including 9 males and 3 females with average age of 48.1 years at the time of death) were used to observe the anatomical integrity and the compactness of the sternocleidomastoid fascial sheath and its relationship with the carotid sheath. ⋯ Satisfaction regarding cosmetic and functional outcomes was considered excellent in 13 patients, good in 7 patients, and fair in 2 patients. The fascial sheath of the sternocleidomastoid muscle is easily isolated from the carotid sheath. This anatomical feature is the basis of division of the sternocleidomastoid muscle and can improve the safety and effectiveness of surgical treatment for CMT in patients older than 6 years old.
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Congenital proximal radioulnar synostosis is a rare genetic malformation of the upper limb. This deformity, which is found mainly in preschool-aged children, has no recognized diagnosis and treatment. Current diagnostic methods cannot effectively assess both bone structure and soft tissue abnormalities, and most surgical treatments introduce complications and do not prevent recurrence. More work is needed; therefore, to address the diagnosis and treatment of this disease. ⋯ The findings from this case suggest that we should carefully monitor all patients younger than 6 years old who report long-term issues with forearm rotation. This case also highlights the need to assess soft tissue and epiphysis abnormalities in addition to bone assessments via digital radiography and 3-dimensional computed tomography. We suggest that surgery should not be performed until the proximal radius epiphysis has closed. Not all cases require surgical treatment, but when surgery is needed, a suitable method should be selected according to the individual needs of the patient. Any surgery performed should treat both the bony malformations and soft tissue abnormalities to maximize the therapeutic effect and reduce complications during and after surgery.
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This study was conducted with the aim of determining pain acceptance levels in patients with chronic pain attending an algology outpatients' department. The research was conducted as a descriptive and cross-sectional study. The population of the study consisted of 97 patients with chronic pain who attended the Algology Outpatients' Department of the Health Implementation and Research Center of Bursa Uludağ University. ⋯ A statistically significant difference was found between the participants' total score means and their sub-score means according to their education level and frequency of experiencing pain (P < .05), but no statistically significant difference was found according to such factors as age, profession, marital status, or medications used (P > .05). It was found that female sex was generally exposed to chronic pain, and factors such as age, marital status, and drug treatment did not differ in the rate of acceptance of chronic pain, and the rate of acceptance of pain in workers was higher, those with lower education level were lower. There is a need that new studies with larger sample groups regarding the factors affecting the acceptance of chronic pain.
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The aim of this study was to discriminate malignant and benign clinical T1 renal masses on routinely acquired computed tomography (CT) images using radiomics and machine learning techniques. Adult patients undergoing surgical resection and histopathological analysis of clinical T1 renal masses were included. Preoperative CT studies in venous phase from multiple referring centers were included, without restriction to specific CT scanners, slice thickness, or degrees of artifacts. ⋯ Sensitivity was significantly higher for RF versus radiologists (0.88 vs 0.80, P = .045), whereas specificity was numerically higher for RF (0.67 vs 0.50, P = .083). Although limited by an overall small sample size and few benign renal tumors, a radiomic features and machine learning approach suggests a high diagnostic accuracy for discrimination of malignant and benign clinical T1 renal masses on venous phase CT. The presented algorithm robustly outperforms human readers in a real-life scenario with nonstandardized imaging studies from various referring centers.
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Observational Study
High neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predict poor survival in rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy.
This study explored the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy (CCRT). Between January 2006 and December 2016, 184 patients with newly-diagnosed rectal cancer receiving neoadjuvant CCRT were enrolled. Risk of overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method and Cox proportional hazard models. ⋯ Further stratified analysis indicated that yp stage II and III patients with high NLR had worse 5-year DFS (aHR = 2.334; 95% CI: 1.158-4.725; P = .018) and OS (aHR = 2.226; 95% CI: 1.165-4.251; P = .015). Additionally, yp stage II and III patients with high PLR had inferior 5-year DFS (aHR = 2.012; 95% CI: 1.049-3.861; P = .036). Pre-CCRT NLR and PLR are independent prognostic factors for rectal cancer patients and could be used as a potential biomarker to identify high-risk patients for more intense treatment and care.