Introduction: The primary issue following lumbar discectomy for disc herniation is the risk of reherniation in the post-operative period. Many surgical techniques have been proposed to treat disc reherniation, however, the optimal one remains variable. This meta-analysis aimed to investigate the prevalence of symptomatic reherniation after using a Bone-anchored annular closure device following lumbar discectomy and the contributing factors. Materials and methods: Identification of published literature was performed on PubMed, Google Scholar, Scopus, and Web of Science databases. Studies published until 14 February 2024 reported the prevalence of symptomatic reherniation after using a Bone-anchored annular closure device following lumbar discectomy and the associated contributing factors. A random effects model was used to conduct Bayesian frequentist network meta-analysis and pair-wise meta-analysis, with the assessment based on standardised mean difference (SMD) and 95% confidence interval (CI). Results: Eleven studies published in 2012 − 2022 recruiting a total of 5195 patients were included in the meta-analysis. The prevalence of reherniation in ACD and control groups was 23.2% (95% CI: 18.2% − 28.1%) and 36.4% (95% CI: 28.2% − 44.5%), respectively. The moderator effect of sample size is significant for pooled data of the ACD group (p-mod=0.002), but not for the control group (pmod=0.278). After the adjustment with sample size, the prevalence rates were 13.6% (95% CI: 6.2% − 21.1%) and 29.6% (95% CI: 14.9% − 33.2%) for ACD and control groups, respectively. Conclusion: Comparatively to lumbar discectomy alone, using a Bone-anchored annular closure device following lumbar discectomy decreased the symptomatic reherniation rate and post-operative complications, as well as the necessity for subsequent surgeries.

The critical shortage of liver transplant donors necessitates innovative solutions,with xeno-transplantation emerging as a promising alternative.Despite significant ethical,scientific,and practical challenges,recent advancements in liver xenotransplantation,particularly using pigs as donors for non-human primates(NHPs),have extended graft survival duration.However,life-threatening issues such as thrombocytopenia and coagulation disorders persist,limiting survival to under a month.Advances in genetic engineering have enabled the modification of pig genomes to match the human immune system better,targeting genes responsible for immune rejection and increasing compatibility.While these breakthroughs enhance the potential for human transplantation,the challenges of immune rejection and long-term functionality remain substantial.This review highlights recent progress in liver xeno-transplantation from pigs to NHPs and explores the implications for potential human clinical application.

Objective: In 2022, the New South Wales TB Program was notified of genomically clustered Mycobacterium tuberculosis isolates from two smear-positive tuberculosis (TB) patients diagnosed 3 months apart. Secondary investigations found they resided in the same Sydney boarding house. The objective of this study was to investigate this cluster and conduct active case finding among contacts. Methods: We conducted a site visit to understand transmission risk, reviewed patient histories, performed a risk assessment and conducted on-site TB contact screening, including interferon-gamma release assay testing. Long-term residents were also screened via chest X-ray. Past residents were referred to local TB services. Results: Four residents with TB disease were identified, three of whom were genomically linked to the cluster. The exposure period in the boarding house was determined to be from January 2021 to September 2022. All residents and staff were considered contacts requiring screening. Of the 91 contacts identified, 37 (41%) completed screening, including 20 (22%) who attended the on-site clinic. Among those screened, one resident with TB disease (patient 4) and three residents and one staff member with TB infection were identified. Discussion: This cluster highlights the role of genomic sequencing in detecting TB transmission. The first three patients were infectious for prolonged periods before diagnosis, likely facilitating transmission in communal areas. In multidwelling buildings with TB exposures, contact screening of all residents may be required when prolonged exposures are found. Strategies to increase screening completion should be further explored.

Objectives: . This experimental study compared the precision and surgical outcomes of manual versus robotic electrode insertions in cochlear implantation. Methods: . The study was conducted on formalin-fixed cadaveric heads, with nine senior neurotologists performing both manual and robotic insertions. Results: . The results showed no statistically significant differences between the two methods in terms of insertion angle, cochlear coverage, or electrode coverage. However, the robotic method demonstrated a significantly slower and more controlled insertion speed (0.1 mm/sec) compared to manual insertion (0.66±0.31 mm/sec), which is crucial for minimizing intra-cochlear force and pressures. Although robotic insertions resulted in fewer complications such as tip fold-over or scala deviation, there were instances of incomplete insertion. Conclusion . The robotic system provided a consistent and controlled insertion process, potentially standardizing cochlear implant operations and reducing outcome variability. The study concludes that robotic-assisted insertion offers significant advantages in controlling insertion speed and consistency, supporting the continued development and clinical evaluation of robotic systems for cochlear implant surgery.

Background: s/Aims: To determine short-term and long-term outcomes after pancreas preserving total duodenectomy (PPTD). Methods: A case series and a complementary meta-analysis were conducted. All patients with (pre)neoplastic lesions of duodenum who underwent PPTD in a tertiary center for pancreatic surgery between May 2009 and October 2022 were included for the case series.All studies in the literature with a sample size of 10 or more patients reporting outcomes of PPTD were included for the meta-analysis. Results: A total of 439 patients (18 from case series and 421 from literature) were analyzed. Clavien-Dindo (CD) I complications in 2.9% (95% confidence interval [CI] 0.6%–5.2%), CD II complications in 21.1% (14.6%–27.6%), CD III complications in 18.1% (9.3%–26.9%), CD IV complications in 2.7% (0.5%–4.9%), and CD V complications in 2.2% (0.2%–4.2%) of patients were found. Probabilities of overall survival and recurrence-free survival at 15 years were 87% and 86%, respectively. There was no significant difference in the risk of mortality (odds ratio [OR]: 0.82, p = 0.830), total complications (OR: 0.77, p = 0.440), postoperative pancreatic fistula (OR: 0.43, p = 0.140), delayed gastric emptying (OR: 0.70, p = 0.450), or postoperative bleeding (OR: 0.97, p = 0.960) between PPTD and pancreaticoduodenectomy. Conclusions PPTD is safe and feasible for (pre)neoplastic lesions of duodenum not involving the pancreatic head. The risk of severe complications (CD > III) is low and long-term outcomes are favorable. Whether PPTD provides advantages over more radical techniques in terms of long-term outcomes remains controversial and requires further research.

Background: Pneumatization of turbinates, also known as concha bullosa (CB), is associated with nasal septal deviation and sinonasal pathologies. This study aims to evaluate the performance of deep learning models in detecting CB in coronal cone-beam computed tomography (CBCT) images. Methods: Standardized coronal images were obtained from 203 CBCT scans (83 with CB and 119 without CB) from the radiology archives of a dental teaching hospital. These scans underwent preprocessing through a hybridized contrast enhancement (CE) method using discrete wavelet transform (DWT). Of the 203 CBCT images, 162 were randomly assigned to the training set and 41 to the testing set. Initially, the images were enhanced using a CE technique before being input into pre-trained deep learning models, namely ResNet50, ResNet101, and MobileNet. The features extracted by each model were then flattened and input into a random forest (RF) classifier. In the subsequent phase, the CE technique was refined by incorporating DWT. Results: CE-DWT-ResNet101-RF demonstrated the highest performance, achieving an accuracy of 91.7% and an area under the curve (AUC) of 98%. In contrast, CE-MobileNet-RF recorded the lowest accuracy at 82.46% and an AUC of 92%. The highest precision, recall, and F1 score (all 92%) were observed for CE-DWT-ResNet101-RF. Conclusion Deep learning models demonstrated high accuracy in detecting CB in CBCT images. However, to confirm these results, further studies involving larger sample sizes and various deep learning models are required.

Inflammatory myofibroblastic tumor (IMT) of the soft tissues of the neck is a rare pathological entity. We present the case of a 32-year-old patient who had a painful, slowly enlarging mass in the neck’s soft tissues. Radiological examination revealed a well-defined, dense lesion. The mass was surgically removed through local excision. Immunohistological analysis confirmed the diagnosis of IMT. After nearly 2 years of follow-up, there was no evidence of recurrence or distant metastases. In conclusion, although IMT of the soft tissues of the neck is uncommon, it should be considered in the differential diagnosis of neck tumors. Further research is necessary to understand the pathogenetic mechanisms of IMT, which could lead to the development of more effective treatments for this tumor.

Purpose: This study evaluated the sensitivity, specificity, and accuracy of computed tomographic angiography (CTA) versus handheld Doppler (HHD) in detecting perforators for anterolateral thigh (ALT) flap surgery. Methods: This study was conducted on 20 patients randomly assigned to two groups from April 2023 to November 2024: One group received CTA and HHD, while the other group received only HHD. Perforators were evaluated for their number, location, and source and compared with intraoperative findings. Results: The sensitivity and specificity of CTA were 86.0% and 98.0%, respectively, while those of HHD were 81.0% and 86.5%. CTA exhibited an accuracy of 92.0% for perforator identification, whereas that of HHD was 83.5%. Conclusion CTA offers higher sensitivity, specificity, and accuracy in identifying ALT flap perforators than HHD. Its superior imaging capabilities can enable improved surgical planning, minimizing intraoperative challenges, reducing the risk of complications, and potentially increasing flap survival rates. As such, CTA could be considered a valuable standard tool in preoperative planning for ALT flap surgery, particularly in cases where anatomical variation poses a challenge.