Citations

Background: In Kienböck disease with carpal collapse scaphocapitate fusion (SCF) and proximal row carpectomy (PRC), are mainstays of surgical treatment. This study analyzed objective and patient-reported outcomes after SCF or PRC in laborers versus nonlaborers. Methods: A retrospective cohort study of patients who underwent surgery for Kienböck disease within a single health system from 1976 to 2023 was conducted. Postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores were surveyed from the available population. Labor status, grip, ROM, and return to the operating room were collected and radiographs were analyzed. Results: Sixty-four patients underwent PRC, and 78 underwent SCF. Patients with PRC were significantly older than patients with SCF. Mean follow-up was 29 months (SD, 53 months). There was no significant difference in postoperative ROM or relative grip strength between the cohort groups. Laborers who underwent SCF demonstrated the least disability on DASH scores. There was no significant difference in postoperative DASH scores in PRC when comparing laborers versus nonlaborers. In contrast, the DASH and PRWE scores of patients who underwent SCF postoperatively varied between laborers and nonlaborers (mean ± SD, 11.1 ± 13.9 versus 30.5 ± 24.8, P = 0.005; and 17.5 ± 19.4 versus 42.3 ± 31.4, P = 0.024). Patients who underwent SCF had a greater rate of revision surgery compared with the PRC group (22 of 78 versus 6 of 64; P = 0.026). Wrist fusion rates were 19% for SCF compared with 1.6% for PRC ( P = 0.0007). Conclusions: SCF and PRC demonstrated no difference in postoperative ROM and grip based on labor status. Laborers with SCF had the least postoperative disability on DASH; however, SCF was associated with the need for additional surgical intervention and conversion to total wrist arthrodesis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutc, III.

Summary: Computer vision has emerged as a useful technology that may prove capable of facilitating remote clinical examinations in hand surgery. This study’s primary aim is to evaluate the efficacy of computer vision for assessing peripheral motor function and range of motion of the hand for future clinic and telemedicine purposes. Five healthy volunteer subjects (10 hands total) were filmed performing three static hand examinations (“peace sign,” “hitchhiker thumb,” and “OK sign”) as well as apposition. Videos were processed using the proprietary H.AI.ND program based on the MediaPipe API (Google, v0.9.2.1), generating temporal and spatial data for joint angle analysis. The median joint angles determined for each test were compared with their manually derived counterparts to assess accuracy and reliability. The measurements were compared at a population level using Wilcoxon signed rank tests and at the individual video level using interclass correlation analyses. The artificial intelligence–generated angle outputs demonstrated a high level of reliability when compared with manually determined measurements for the 3 clinical positions included in this study. Assessment of compound appositional movement also demonstrated high reliability with time-dependent multijoint evaluation. Goniometric analysis through computer vision applications may provide an easy and reliable alternative for hand evaluation in the normal population for both static and dynamic function. Further study is warranted to evaluate this program’s potential role for diagnostic assessment in the diseased population before and after surgical investigation.

Background: Mandible contour significantly influences facial appearance, framing the lower facial silhouette. Redefining mandibular contour is key for facial and neck rejuvenation. Yet, there is limited facial aging research across different lifespans and sexes. Here, we utilize artificial intelligence and advanced 3-dimensional (3D) analysis to elucidate mandibular aging patterns in male and female subjects. Methods: A retrospective analysis of facial computed tomography scans in White patients was conducted, categorizing subjects into 3 age groups (20–79 y) and stratifying them by sex. Artificial intelligence–assisted segmentation into 3D mandibles was done in Mimics v.25, and statistical shape modeling was used to create an average mandible for each group. Volume and linear measurements were assessed via 3D overlays. Results: Analysis of 280 mandibles demonstrated statistically significant aging changes in both sexes. Ramus height showed a marked decrease with age, by approximately 5.3 mm in women and 4.2 mm in men (P < 0.001). Interrami and intercondylar widths increased by a mean of 4–5 mm (P < 0.01). Women exhibited an increase in mandibular angle (P < 0.01), and bony resorption over the chin compared to men, who exhibited concentrated bone resorption at the gonion projection. Conclusions: Mandibular aging, independent of tooth loss, exhibits specific bone remodeling patterns by sex. Posteriorly, mandibular widths increase in both sexes, whereas ramus height decreases. Women experience more resorption at the anterior alveolar surface and chin than men. Statistical shape modeling effectively visualizes these patterns on a population level, bridging the gap between traditional aging research and current understanding.

Abstract Aims This study aims to describe the prevalence of discordant mild/moderate aortic stenosis (AS) in a population-based study and to identify the mechanisms that lead to reduced stroke volume (SV) and discordant moderate AS. Methods and results Discordant high-gradient (HG)-mild AS, defined as AVA &gt; 1.5 cm2 and mean pressure gradient (MG) of 20–40 mmHg, and discordant low-gradient (LG) moderate AS, defined as AVA 1.0–1.5 cm2 and MG &lt; 20 mmHg, were assessed in 883 individuals from the DANCAVAS screening study with aortic valve calcification and 257 individuals form the PROGRESSA study excluding those with left ventricular (LV) ejection fraction &lt; 50%. In the DANCAVAS cohort, 150 men had mild/moderate AS of which 34% had discordance between MG and AVA, representing 66% with moderate AS. Among 262 patients in the combined cohort, 39% had discordant LG-moderate AS and 6% discordant HG-mild AS. Compared with concordant mild and moderate AS, individuals with discordant LG-moderate AS were more likely to present with LV concentric remodelling geometry (26 vs. 33 vs. 45%, P &lt; 0.001), increased valvulo-arterial impedance (3.3 ± 0.7 vs. 3.6 ± 0.5 vs. 4.1 ± 0.7 mmHg/mL/m2, P &lt; 0.001), and reduced systemic arterial compliance (SAC) (0.74 ± 0.22 vs. 0.81 ± 0.22 vs. 0.64 ± 0.18 mL/m2/mmHg, P &lt; 0.001). Factors associated with SV index were relative wall thickness, LV end-diastolic diameter index, SAC, and LV remodelling pattern. Conclusion Discordant moderate AS is common, accounting for two-thirds of patients with moderate AS in the general male population. Patients with discordant LG-moderate AS have predominantly a concentric remodelling pattern with reduced SV. Reduced SV index was associated with signs of reduced vascular compliance, suggesting that altered vascular properties drive differences in remodelling patterns and discordant moderate AS.

AbstractObjectiveThe primary goal of this study was to measure health‐state utility values (HUVs) in patients with facial paralysis before and after treatment. A secondary objective was to compare these values with those of other chronic diseases and currently available treatments.Study DesignA retrospective chart review.SettingA tertiary medical center.MethodsAdults with flaccid and non‐flaccid facial paralysis were included. Baseline demographics, medical comorbidities, facial paralysis history, treatment details, and disease‐specific quality‐of‐life scores were collected. Utility values were derived using the Short‐Form 6D health index at baseline and after treatment.ResultsThe mean baseline Short‐Form 6D utility value for patients with facial paralysis (n = 134) was 0.73 (± 0.14) (95% confidence interval [CI]: 0.71‐0.75). Baseline utility values significantly correlated with disease‐specific quality of life as measured by the Facial Clinimetric Evaluation Scale (r = 0.400; P < .001), but not with Sunnybrook Facial Grading Scale or Synkinesis Assessment Questionnaire scores. Post‐treatment utility values showed a mean improvement of 0.03 (95% CI: −0.01 to 0.08; P = .14) in the overall cohort. The flaccid group showed a greater average improvement compared to the non‐flaccid group (0.05 [± 0.17] vs 0.02 [± 0.17]; P = .62).ConclusionPatients with flaccid and non‐flaccid facial paralysis reported HUVs that were significantly lower than the US population norm. Treatment improved utility values in both groups. These findings provide initial data for future cost‐effectiveness analyses of surgical and non‐surgical treatment options for facial paralysis.

Background: Development of ectropion is a frequently reported complication after reconstruction of infraorbital Mohs defects. This study aimed to characterize preoperative and surgical factors contributing to ectropion development in patients undergoing reconstruction after Mohs micrographic surgery. Methods: We conducted a retrospective single-center case-control study on patients undergoing reconstruction of Mohs micrographic surgery defects involving the nonmarginal lower eyelid and upper cheek from 2011 to 2023. Pre- and postoperative photographs were reviewed to confirm defect location and postreconstructive eyelid malposition. Ectropion risk factors were determined with uni- and multivariate odds ratio analyses. Results: A total of 202 patients were included, 45 cases in the ectropion group and 157 in the control group. Negative orbital vector (P = 0.02), recurrent disease (P = 0.01), and greater defects size (P = 0.007) were associated with postreconstructive ectropion. Ectropion was more likely after multidisciplinary reconstruction (13.3% versus 1.4%, P < 0.001) and reconstruction with cervicofacial flaps (28.9% versus 4.2%, P < 0.0005); and less likely after primary closure (8.9% versus 28.5%, P < 0.001). Multivariate assessment (odds ratio [95% confidence interval], P value) revealed that combined cheek and eyelid defect involvement (4.32 [1.36–13.6], P = 0.01), larger size (1.07 [1.03–1.13], P < 0.001), and negative orbital vector (12.11 [2.65–65.42], P = 0.002) were independent risk factors for ectropion development. Conclusions: Combined cheek/lower eyelid defects and negative orbital vector increase the risk of postreconstructive ectropion. These findings can be used to optimize surgical technique and counsel patients on increased likelihood of this complication with possible need for revision surgery.

Background: The joint College of American Pathologists/American College of Medical Genetics and Genomics Cytogenetics Committee works to ensure the competency and proficiency of clinical cytogenetic testing laboratories through proficiency testing (PT) programs for various clinical tests offered by such laboratories, including the evaluation of cytogenetic abnormalities in solid tumors. Methods: Review and analyze 25 years (1999–2023) of solid tumor chromosome analysis PT results, utilizing G-banded karyograms. A retrospective review of results from 1999 to 2023 was performed, identifying the challenges addressing solid tumors. The chromosomal abnormalities and overall performance were evaluated. Results: A total of 21 solid tumor challenges were administered during the period 1999–2018. No solid tumor challenges were administered during the period 2019–2023. Challenges consisted of metaphase images and accompanying clinical history for the evaluation of numerical and/or structural abnormalities. All 21 cases reached 80% grading consensus for abnormality recognition. However, five cases (24%) failed to reach consensus for nomenclature reporting by participating laboratories. These cases illustrate errors in reporting chromosomal abnormalities, including whole-arm translocations and those involving sex chromosomes. In addition, they highlight the challenges with differentiation of terminal and interstitial deletions, difficulties in identifying correct breakpoints, and omission of brackets in neoplastic cases. Conclusions: This comprehensive 25-year review demonstrates the exceptional proficiency of cytogenetic laboratories in accurately identifying chromosome abnormalities in solid tumors, while also highlighting the challenges of reporting specific types of chromosomal abnormalities.