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Background/Aims PD-L1 expression is abundant not only in malignant cells but also in infiltrating cells within the tumor microenvironment (TME) of hepatocellular carcinoma (HCC). This study explored the association between PD-L1 expression in TME and outcomes in HCC patients treated with atezolizumab plus bevacizumab (AB), emphasizing the implications of PD-L1 expression in both malignant and tumor-infiltrating cells. Methods This retrospective study included 72 patients with HCC who underwent percutaneous core needle liver biopsy before AB treatment between September 2020 and December 2023. PD-L1 expression on tumor tissues was assessed using the combined positive score (CPS) with cutoff values of 1 and 10, utilizing antibody clone 22C3 (Dako). Results The distribution of PD-L1 CPS included 24 patients with CPS <1, 33 patients with CPS 1–10, and 15 patients with CPS ≥10. Significant differences in OS were observed across the three groups, with CPS ≥10 showing the highest survival rates (p=0.010). Patients with CPS ≥10 had better OS than those with CPS <10 (mOS 14.8 vs. 8.3 months, p=0.046), and CPS ≥1 had better OS than CPS <1 (p=0.021). For PFS, the CPS ≥10 group had the highest mPFS of 11.0 months among the three groups (p=0.044). Objective response rates (ORR) were higher in the PD-L1 CPS ≥10 group than in the 1-10 and <1 group (53.3%, 27.3%, and 16.7%, respectively; p=.047). Multivariate analysis identified that PD-L1 expression ≥10 and ≥1 were associated with favorable outcomes regarding OS (hazard ratio [HR] 0.283, p=.027 and HR 0.303, p=.006, respectively). Conclusion Higher PD-L1 expression in malignant and tumor-infiltrating cells was associated with better OS, PFS, and ORR in patients with HCC treated with AB. [ABSTRACT FROM AUTHOR]

Background: This study investigated the efficacy and safety of combined subacromial and intravenous patient-controlled analgesia for control of postoperative pain after arthroscopic rotator cuff repair. Methods: Between May 2012 and August 2014, 60 patients who underwent arthroscopic rotator cuff repair with acromioplasty and received patient-controlled analgesia were studied prospectively. Cases were divided into 2 groups: combined subacromial and intravenous infusion group (group A, 30 cases) and solitary intravenous infusion group (group B, 30 cases). The visual analogue scale was used to record the patient's level of pain every 12 hours during postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. Results: The mean preoperative visual analogue scale score was 7.8 in group A and 7.6 in group B, and the immediate postoperative visual analogue scale score was 7.9 and 8.1 for each group. At postoperative time (From 12 hours to 72 hours after operation), the scores of combined subacromial and intravenous infusion were significantly lower than those of solitary intravenous infusion. Significant difference in the frequency of supplemental analgesic injections was observed between group A and group B (p=0.008). However, no significant difference in complication rate was observed between the two groups (p=0.562). Conclusions: Combined subacromial and intravenous patient-controlled analgesia after arthroscopic rotator cuff repair is more effective than solitary intravenous infusion without significantly increasing complications. Therefore, combined subacromial and intravenous patient-controlled analgesia could be a effective pain control method. [ABSTRACT FROM AUTHOR]

Purpose We attempted to identify changes in back muscle atrophy occurring in multilevel minimally invasive transforaminal interbody fusion (MITLIF) and the impact of these changes on clinical outcomes. Methods This study was conducted on 92 patients who underwent unilateral MITLIF between 2006 and 2013, had been tracked with a follow-up for at least 1 year, and had been assessed by pre- and postoperative computed tomography (CT). For the clinical evaluation, a pre- and postoperative visualized analog scale (VAS) of the back and legs, and Oswestry Disability Index (ODI) were measured. CT was used for the evaluation of back muscle atrophy and a cross-sectional area (CSA) of the multifidus was measured at the level below a fused segment, excluding metal artifacts. Results There was no significant difference in the reduction of CSA between groups with one-, two-, or three-plus-segment fusion. In addition, no statistically significant differences were found in the pre- and postoperative VAS of the back, VAS of the legs, and ODI between the three groups. The reduction of CSA showed a statistically significant positive correlation with preoperative VAS of the back (p = 0.025, r = 0.562). On the other hand, no significant difference was found in VAS of the leg (p = 0.437, r = 0.082) and ODI (p = 0.106, r = 0.017). Conclusion When performing unilateral multilevel MITLIF, significant difference was not found in the atrophy of the multifidus according to the number of fused segments. The clinical outcomes also showed no significant difference. Therefore, unilateral MITLIF can be considered to be an effective surgical method to minimize lumbar muscle damage, even at multiple levels. [ABSTRACT FROM AUTHOR]

Baker's cyst is a distension of the gastrocnemius-semimembranosus bursa of the knee, which communicates with the posterior portion of the joint capsule. Baker's cyst is commonly located in the inferomedial or superficial layers of the knee joint and rarely extends laterally or proximally. Complications of Baker's cysts are dissection, rupture, pseudothrombophlebitis, leg ischemia, nerve entrapment, and compartment syndrome. However, hematomas in the Baker's cyst have not been reported in Korea. We report a rare case of hematoma in the Baker's cyst with subfascial extension into the calf. The hematoma was demonstrated by magnetic resonance imaging and removed by mass excision. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study. Purpose: This study aims to investigate the clinical and radiological results of contralateral indirect decompression through minimally invasive unilateral transforaminal lumbar interbody fusion (MI-TLIF). Overview of Literature: Several studies have proposed that blood loss and operation time could be reduced through a unilateral approach, although many surgeons have forecast that satisfactory foraminal decompression is difficult to achieve through a unilateral approach. Methods: The study included 30 subjects who had undergone single- level MI-TLIF. Visual analogue scale (VAS) and Oswestry disability index (ODI) were analyzed for clinical assessment. Disc height, segmental lordosis, and lumbar lordosis angle were examined for radiological assessment. The degree of contralateral indirect decompression was evaluated through a comparative analysis, with a magnetic resonance imaging (MRI) performed preoperatively and at one year postoperatively. Results: Intraoperative blood loss volume was 308.75 mL in the unilateral approach group (UAP), and 575.00 mL in the bilateral approach group (BAP), showing a statistically significant difference. Operation time was 139.50 minutes in the UAP group, and 189.00 minutes in the BAP group, exhibiting a statistically significant difference (p <0.05). On the other hand, no significant difference was found in VAS, ODI, disc height, lordosis angles and the degree of nerve decompression in the vertebral foramen, using MRI, between the two groups (p >0.05) Conclusions: Satisfactory results were acquired with MI-TLIF conducted through the unilateral approach of contralateral indirect decompression, in alignment with the bilateral approach. Therefore, contralateral indirect decompression is thought to be a useful procedure in reducing the operation time and volume of blood loss. [ABSTRACT FROM AUTHOR]

Angular deformities of the distal femur occur in congenital diseases or due to acquired causes, such as malunion after a fracture of the distal femur. Angular deformities of the lower extremities affect the mechanical axis, causing changes in the weight pressure on the articular surface. As a result, angular deformities quicken the progression of osteoarthritis. Therefore, correction of deformities should be performed to prevent the progression of osteoarthritis. Distal femoral osteotomy is one of the methods to correct angular deformities in unicompartmental osteoarthritis. However, femoral supracondylar dome osteotomy with retrograde intramedullary nailing in the distal femur with a varus deformity has been rarely reported. Herein, we describe a technique for femoral supracondylar dome osteotomy with retrograde intramedullary nailing in a varus deformity after a pathologic fracture of giant cell tumor in the distal femur with a review of the relevant literature. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to analyze the fusion rate according to the mixture ratio and the amount of bone graft in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Materials and Methods: This study included 92 subjects who underwent MI-TLIF. Patients were classified into either group I, in which patients received transplantation with only autogenous bone, group II, in which patients received transplantation with hydroxyapatite mixed with autogenous bone by more than 50%, or group III, in which patients received transplantation with hydroxyapatite mixed with autogenous bone by less than 50%. For analysis of the correlation of amount of bone graft with fusion rate, patients were divided into group A, having less than 12 ml of bone graft, and group B, having more than 12 ml of bone graft. Visual analogue scale and Oswestry disability index were used for clinical assessment, and Burkus' classification method was used for evaluation of bone fusion. Results: Fusion rates of groups I, II, and III according to the mixture ratio were 90.9%, 86.5%, and 86.2%, respectively. The fusion rate increased as the autobone ratio became higher; however, no significant difference was found (p=0.16). The fusion rates were 81.5% and 92.5% in group A and group B, respectively, which were classified according to the volume of bone graft, showing a significant increase in groups with bone graft volume more than 12 ml (p=0.03). Conclusion: A significantly high fusion rate was observed when bone graft volume was more than 12 ml in MI-TLIF. More than 12 ml of bone graft volume is essential for achievement of a satisfactory fusion rate [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyze the influence of posterior tibial slope on stability in clinical and second-look arthroscopic evaluation after anterior cruciate ligament (ACL) reconstruction. Materials and Methods: From 2000 to 2011, 124 patients who underwent ACL reconstruction using an allogaft were enrolled in this study. A posterior tibial slope between 0° and 4° was found in 28 patients (group A), between 5° and 9° in 64 patients (group B), and greater than 10° in 32 patients (group C). We evaluated stability using the Lachman test and a KT-2000 arthrometer. In second-look arthroscopy, grafted tendons were evaluated based on the tension, rupture, and synovial coverage. Results: In clinical evaluation for stability, mean KT-2000 arthrometer and Lachman test at last follow-up showed no statistically significant differences depending on posterior tibial slope. Second-look arthroscopic findings showed no statistically significant difference between groups A and B (p=0.91). However, statistically significant relations were observed between groups A and C (p=0.03), and between groups B and C (p=0.02). Conclusion: The results of this study suggest that patients who underwent ACL reconstruction with higher posterior tibial slope (⩾10°) have more lax tension in second-look arthroscopy, but not in clinical stability tests. [ABSTRACT FROM AUTHOR]

Rare cases of a congenital absence of the long head of the biceps tendon (LHBT) have been reported, and its incidence is unknown. In a literature review of the congenital absence of the LHBT, only 1 case was associated with posterior shoulder instability and severe posterior glenoid dysplasia. This paper reports the first case of a patient with a bilateral congenital absence of the LHBT with posterior shoulder instability without glenoid dysplasia or posterior glenoid tilt. The patient experienced a traffic accident while holding the gear stick with his right hand. After the accident, a posteroinferior labral tear with paralabral cysts was detected on the magnetic resonance images. The congenital absence of the LHBT was assumed to have affected the posterior instability that possibly increased the susceptibility to a subsequent traumatic posterior inferior labral tear. This case was identified as a posterior inferior tear caused by a traumatic 'gear stick injury'. [ABSTRACT FROM AUTHOR]