Introduction: Triple Arthrodesis is the preferred surgical treatment of stage III Adult Acquired Flatfoot Deformity. However, studies have reported subsequent midfoot degenerative arthrosis, with medial column instability. Materials and methods: This is a retrospective study using prospectively collected registry data from a single tertiary institution. Between 2007 to 2014, all patients who had undergone Triple Arthrodesis with concomitant percutaneous Tendo-Achilles lengthening were included. Patients with previous foot surgery, revision surgeries, and concomitant surgical procedures were excluded. We aim to report on our two years outcomes using the hindfoot and midfoot AOFAS and VAS scores, as well as radiographic parameters such as first-metatarsal declination angle, medial cuneiform calcaneal angle, navicular height, medial cuneiform – first metatarsal cuneiform angle, calcaneal pitch and medial longitudinal arch. Results: There were 22 feet from 21 patients that met the criteria of having undergone Triple Arthrodesis with concomitant percutaneous Tendo-Achilles lengthening. Hindfoot and midfoot American Orthopaedic Foot and Ankle Society (AOFAS) scores improved by an average of 34.6 and 36.7 points at 24-months post-surgery (p<0.001). Between six months to two years post-operatively, there was evidence of mid-foot sagging as shown with an increase in CalcanealFirst metatarsal angle by a mean of 5.1° (p=0.001). Additionally, a decrease in the Calcaneal Pitch Angle by 2.9° (p=0.003) and Cuneiform-Calcaneal angle by 5.5° (p=0.000). Navicular Height also decreased significantly by 2.8mm (p=0.001) over this period. A total of 18 (85.6%) reported overall satisfaction being met at the time of a phone survey, at an average of 8.3 years (range 5.8 to 12.4) postsurgery. One patient required an ankle replacement, and another had removal of hardware done. Conclusion: Triple arthrodesis with concomitant TendoAchilles lengthening results in significant improvement in AOFAS mid-foot and hindfoot scores at two years. At two years mark, there was features of mid-foot sagging postoperatively, despite continued improvement in AOFAS scores. Eighteen of the 21 patients were satisfied with the outcomes, on a phone survey, at an average of 8.3 years postsurgery.

Using prostate-specific antigen (PSA) for prostate cancer (PCa) screening led to overinvestigation and overdiagnosis of indolent PCa. We aimed to investigate the value of prostate health index (PHI) and magnetic resonance imaging (MRI) prostate in an Asian PCa screening program. Men aged 50-75 years were prospectively recruited from a community-based PSA screening program. Men with PSA 4.0-10.0 ng ml -1 had PHI result analyzed. MRI prostate was offered to men with PSA 4.0-50.0 ng ml -1 . A systematic prostate biopsy was offered to men with PSA 4.0-9.9 ng ml -1 and PHI ≥35, or PSA 10.0-50.0 ng ml -1 . Additional targeted prostate biopsy was offered if they had PI-RADS score ≥3. Clinically significant PCa (csPCa) was defined as the International Society of Urological Pathology (ISUP) grade group (GG) ≥2 or ISUP GG 1 with involvement of ≥30% of total systematic cores. In total, 12.8% (196/1536) men had PSA ≥4.0 ng ml -1 . Among 194 men with PSA 4.0-50.0 ng ml -1 , 187 (96.4%) received MRI prostate. Among them, 28.3% (53/187) had PI-RADS ≥3 lesions. Moreover, 7.0% (107/1536) men were indicated for biopsy and 94.4% (101/107) men received biopsy. Among the men received biopsy, PCa, ISUP GG ≥2 PCa, and csPCa was diagnosed in 42 (41.6%), 24 (23.8%), and 34 (33.7%) men, respectively. Compared with PSA/PHI pathway in men with PSA 4.0-50.0 ng ml -1 , additional MRI increased diagnoses of PCa, ISUP GG ≥2 PCa, and csPCa by 21.2% (from 33 to 40), 22.2% (from 18 to 22), and 18.5% (from 27 to 32), respectively. The benefit of additional MRI was only observed in PSA 4.0-10.0 ng ml -1 , and the number of MRI needed to diagnose one additional ISUP GG ≥2 PCa was 20 in PHI ≥35 and 94 in PHI <35. Among them, 45.4% (89/196) men with PSA ≥4.0 ng ml -1 avoided unnecessary biopsy with the use of PHI and MRI. A screening algorithm with PSA, PHI, and MRI could effectively diagnose csPCa while reducing unnecessary biopsies. The benefit of MRI prostate was mainly observed in PSA 4.0-9.9 ng ml -1 and PHI ≥35 group. PHI was an important risk stratification step for PCa screening.
Humans ; Male ; Early Detection of Cancer/methods* ; East Asian People ; Image-Guided Biopsy/methods* ; Magnetic Resonance Imaging/methods* ; Prostate/pathology* ; Prostate-Specific Antigen ; Prostatic Neoplasms/pathology* ; Retrospective Studies ; Middle Aged ; Aged

INTRODUCTION: Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore. METHODS: Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission. RESULTS: Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5). CONCLUSION The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.
Abortion, Spontaneous/epidemiology* ; Adult ; COVID-19/transmission* ; COVID-19 Nucleic Acid Testing ; COVID-19 Serological Testing ; Cohort Studies ; Disease Transmission, Infectious/statistics & numerical data* ; Female ; Fetal Blood/immunology* ; Humans ; Infectious Disease Transmission, Vertical/statistics & numerical data* ; Live Birth/epidemiology* ; Maternal Age ; Milk, Human/virology* ; Obesity, Maternal/epidemiology* ; Placenta/pathology* ; Pregnancy ; Pregnancy Complications, Infectious/physiopathology* ; Pregnancy Outcome/epidemiology* ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Prospective Studies ; RNA, Viral/analysis* ; Risk Factors ; SARS-CoV-2 ; Severity of Illness Index ; Singapore/epidemiology* ; Umbilical Cord/pathology* ; Young Adult

Introduction: There is no large population size study on school screening for scoliosis in Malaysia. This study is aimed to determine the prevalence rate and positive predictive value (PPV) of screening programme for adolescent idiopathic scoliosis. Materials and Methods: A total of 8966 voluntary school students aged 13-15 years old were recruited for scoliosis screening. Screening was done by measuring the angle of trunk rotation (ATR) on forward bending test (FBT) using a scoliometer. ATR of 5 degrees or more was considered positive. Positively screened students had standard radiographs done for measurement of the Cobb angle. Cobb angle of >10° was used to diagnose scoliosis. The percentage of radiological assessment referral, prevalence rate and PPV of scoliosis were then calculated. Results: Percentage of radiological assessment referral (ATR >5°) was 4.2% (182/4381) for male and 5.0% (228/4585) for female. Only 38.0% of those with ATR >5° presented for further radiological assessment. The adjusted prevalence rate was 2.55% for Cobb angle >10°, 0.59% for >20° and 0.12% for >40°. The PPV is 55.8% for Cobb angle >10°, 12.8% for >20° and 2.6% for > 40°. Conclusions: This is the largest study of school scoliosis screening in Malaysia. The prevalence rate of scoliosis was 2.55%. The positive predictive value was 55.8%, which is adequate to suggest that the school scoliosis screening programme did play a role in early detection of scoliosis. However, a cost effectiveness analysis will be needed to firmly determine its efficacy.

BACKGROUND: Relationships among portable scanning mobility particle sizer (P-SMPS), condensation particle counter (CPC), and surface area monitor (SAM), which are different metric measurement devices, were investigated, and two widely used research grade (RG)-SMPSs were compared to harmonize the measurement protocols. METHODS: Pearson correlation analysis was performed to compare the relation between P-SMPS, CPC, and SAM and two common RG-SMPS. RESULTS: For laboratory and engineered nanoparticle (ENP) workplaces, correlation among devices showed good relationships. Correlation among devices was fair in unintended nanoparticle (UNP)-emitting workplaces. This is partly explained by the fact that shape of particles was not spherical, although calibration of sampling instruments was performed using spherical particles and the concentration was very high at the UNP workplaces to allow them to aggregate more easily. Chain-like particles were found by scanning electron microscope in UNP workplaces. The CPC or SAM could be used as an alternative instrument instead of SMPS at the ENP-handling workplaces. At the UNP workplaces, where concentration is high, real-time instruments should be used with caution. There are significant differences between the two SMPSs tested. TSI SMPS showed about 20% higher concentration than the Grimm SMPS in all workplaces. CONCLUSIONS: For nanoparticle measurement, CPC and SAM might be useful to find source of emission at laboratory and ENP workplaces instead of P-SMPS in the first stage. An SMPS is required to measure with high accuracy. Caution is necessary when comparing data from different nanoparticle measurement devices and RG-SMPSs.
Calibration ; Nanoparticles*

Disc fragment migration occurs in 35%-72% of lumbar disc herniations. Most of the herniated disc fragments migrate in the rostal, caudal and lateral directions. Posterior epidural disc fragment migration is a rare finding and posterior migration causing Cauda Equina syndrome is exceptionally rare. We report here on two cases of L4-5 disc fragment posterior epidural migration that caused Cauda Equina syndrome, and this was diagnosed by performing radiological examination, and we also include a review of the related literature.
Intervertebral Disc Displacement ; Polyradiculopathy

BACKGROUND: It is stated frequently that patients with spinal block may be drowsy, although they may not have received any sedative drugs. Intrathecal clonidine increase the duration of sensory and motor blockades, and also has a sedative effect. Thus we conducted this study to investigate the effects of spinal anesthesia and intrathecal clonidine on propofol hypnotic requirements. METHODS: Forty-five adult patients scheduled to undergo local or spinal anesthesia were enrolled in this study. Group 1 included patients on local anesthesia, group 2 were patients on spinal anesthesia with 0.5% hyperbaric bupivacaine, and group 3 were patients on spinal anesthesia with 0.5% hyperbaric bupivacaine and 75microgram clonidine. The target controlled infusion (TCI) of propofol was started at a target concentration of 1microgram/ml. We checked the lowest BIS during 5 min observation after the effect site concentration (Ce) had been reached (1microgram/ml). The TCI of propofol was then restarted at a target concentration of 1.5microgram/ml and we checked the lowest BIS during 5 min observation after the Ce had been reached (1.5microgram/ml). We also checked the Ce when the BIS reached 80 and 70. RESULTS: The minimum BIS's at 1 microgram/ml Ceiiwere 86.9 +/- 11.3 (Group 1), 80.5 +/- 8.5 (Group 2) and 66.9 +/- 15.5 (Group 3), and the minimum BIS's at 1.5microgram/ml Ce were 76.0 +/- 13.4, 62.9 +/- 12.4, 48.5 +/- 13.7, respectively. The Ce's of propofol at BIS 80 were checked initially at 1.4 +/- 0.5microgram/ml (Group 1), 1.1 +/- 0.3microgram/ml (Group 2) and 0.8 +/- 0.3microgram/ml (Group 3). The Ce's of propofol at BIS 70 were 1.8 +/- 0.6microgram/ml, 1.4 +/- 0.3microgram/ml and 1.0 +/- 0.3microgram/ml, respectively. The Ce's of Group 2 and Group 3 at BIS 80 and BIS 70 were statistically lower than those of Group 1 (P < 0.05), and the Ce's of Group 3 at BIS 80 and BIS 70 were statistically lower than those of Group 2 (P < 0.05). CONCLUSIONS: Spinal anesthesia and intrathecal clonidine reduce the requirement of propofol for conscious sedation. The Ce of propofol for conscious sedation is 1.4-1.8microgram/ml for local anesthesia, 1.1-1.4microgram/ml for spinal anesthesia with 0.5% hyperbaric bupivacaine, and 0.6-1.0microgram/ml for spinal anesthesia with 0.5% hyperbaric bupivacaine and 75microgram clonidine.
Adult ; Anesthesia, Local ; Anesthesia, Spinal* ; Bupivacaine ; Clonidine* ; Conscious Sedation* ; Humans ; Hypnosis ; Hypnotics and Sedatives ; Propofol*

A 50-year-old man with bladder cancer had spinal anesthesia for transurethral resection of bladder. After he had spinal block at the T8 level, he developed a persistent penile erection, making it impossible to introduce the 24 French cystoscope. To treat a persistent penile erection, intravenous glycopyrrolate was incrementally given for a total of 0.4 mg. A persistent penile erection was markedly subsided 5 minutes after last 0.2 mg glycopyrrolate was given. Then corpus cavernosum blood was aspirated. The cystoscope was easily introduced, and transurethral resection of bladder proceeded without further complication.
Anesthesia, Spinal* ; Cystoscopes ; Glycopyrrolate ; Humans ; Male ; Middle Aged ; Penile Erection* ; Urinary Bladder ; Urinary Bladder Neoplasms

The laryngeal mask airway (LMA) has several advantages over endotracheal intubation for the airway management in tracheal stenosis patients. Endotracheal tubes are narrower than the natural trachea and can induce reflex airway constriction resulting in more resistance to ventilation. Furthermore, an endotracheal tube can injure the trachea, and cause airway edema, and further tracheal constriction. In contrast, the increase in airway resistance that occurs when using the laryngeal mask is relatively low, because the diameter of the laryngeal mask airway is larger than that of the endotracheal tube and the laryngeal mask airway is not intubated. However, patients with a mechanically obstructed trachea, those with tracheomalacia or an external compression of the trachea, cannot be managed with a laryngeal mask airway, because it cannot prevent tracheal collapse. Thus it is important that the causes of tracheal obstruction are differentiated. This report suggests that the laryngeal mask airway can be used as a route for mechanical ventilation and as a conduit for tracheal evaluation and endotracheal intubation using fiberoptic bronchoscope during tracheal reconstruction surgery in patients with tracheal stenosis.
Airway Management ; Airway Resistance ; Bronchoscopes ; Constriction ; Edema ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngeal Masks* ; Reflex ; Respiration, Artificial ; Trachea ; Tracheal Stenosis ; Tracheomalacia ; Ventilation

No abstract available.
Animals ; Epidermal Growth Factor* ; Gene Expression* ; Gonadotropin-Releasing Hormone* ; Pituitary Adenylate Cyclase-Activating Polypeptide* ; Rats*