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Objective To describe 5-year postoperative outcomes of a small series of Fuchs’ endothelial dystrophy (FED) patients who underwent Descemet stripping only (DSO) with a scraping technique. Methods DSO technique and early clinical outcomes of 5 patients with mild central FED were previously reported. In the same cohort of patients, corrected distance visual acuity, central corneal ultrasound pachymetry, refractive spherical equivalent, endothelial cell count, slit-lamp photography, and corneal Scheimpflug tomography were obtained at baseline, 6 months, and 1 and 5 years postoperatively. No patient used topical Rho-kinase inhibitors at any point in time. Results One patient (20%) failed to clear the early postoperative edema and 1 patient (20%) developed corneal decompensation 1 year after DSO. Both patients underwent successful Descemet stripping automated endothelial keratoplasty. The remaining 3 patients had stable corrected distance visual acuity, progressive reduction of corneal ultrasound pachymetry, and mild myopic shift of the refractive spherical equivalent over the follow-up time. An improvement in posterior stromal opacities and irregular astigmatism was observed, whereas posterior elevation at Scheimpflug tomography remained unchanged. Conclusion At 5 years postoperatively, DSO with a scraping technique and without Rho-kinase inhibitors resulted in sustained clinical amelioration of 3 of 5 patients (60%) with mild FED.

In recent years, with the in-depth research on spinal tuberculosis, posterior surgery alone has been praised highly by more and more surgeons due to the better correction of kyphosis, better maintenance of spinal physiological curvature, smaller surgical trauma and fewer surgical complications. However, there is currently lack of relevant reports about the efficacy of posterior surgery alone in the treatment of tuberculosis in the T4-6 segments. This study aimed to evaluate the clinical study efficacy and feasibility of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4-6 segments. 67 patients with tuberculosis in T4-6 segments who underwent one-stage posterior-only surgery were included in this study. The clinical efficacy was evaluated using statistical analysis based on the data about erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Oswestry Dability Index (ODI) score, Visual Analogue Scale (VAS) score and Cobb angle before surgery, after surgery and at the last follow-up. All patients completed fusion during the follow-up period of 6–9 months. ESR and CRP were returned to normal for all patients at 6 months follow-up. In the meanwhile, among the 27 patients combined with neurological impairment, neurological functions of 22 cases (81.48%) recovered completely at the last follow-up (P

Predictors of outcomes in adolescent athletes undergoing hip arthroscopy have not been established. The purpose of this study was to identify factors correlated with achieving the Patient Acceptable Symptomatic State (PASS) for the Hip Outcome Score-Sports Specific Subscale (HOS-SSS) at a minimum 5-year follow-up in adolescent athletes undergoing primary hip arthroscopy.Data were reviewed on adolescent (below 18 y old) athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between March 2008 and October 2015. Patients were included if they participated in sport within 1 year before surgery and had preoperative, 2-year, and minimum 5-year postoperative patient-reported outcome (PRO) scores for the modified Harris Hip Score, HOS-SSS, Visual Analog Scale for pain (VAS), and Non-Arthritic Hip Score (NAHS). Patients were divided into 2 groups based on whether they achieved PASS for HOS-SSS. Demographics, intraoperative findings, radiographic variables, surgical treatments, and PRO were compared. Multivariate logistic regression with corresponding odds ratios (ORs) quantified the correlation between variables and achievement of the PASS.A total of 123 athletes with a mean age of 16.2±1.1 years were included. These athletes demonstrated significant imrpovement from preoperative to minimum 5-year follow-up for all recorded PROs (P0.001). The multivariate logistic regression model identified preoperative NAHS (P=0.019, OR: 1.033), 2-year postoperative HOS-SSS (P=0.014, OR: 1.037), and 2-year postoperative VAS (P=0.003, OR: 0.590) as statistically significantly correlated with achieving the PASS. Athletes with a 2-year postoperative VAS pain score ≤2 achieved PASS at a rate of 81.9%, while those with a score2 achieved PASS at a rate of 24.1% (P0.001, OR: 14.2, 95% confidence interval: 5.23-38.7).Favorable outcome were achieved at mid-term follow-up in adolescent athletes undergoing primary hip arthroscopy. Preoperative NAHS, 2-year postoperative HOS-SSS, and 2-year postoperative VAS pain scores were correlated with achieving the PASS for HOS-SSS at a minimum 5-year follow-up. Patients with 2-year postoperative VAS ≤2 were significantly more likely to achieve the PASS at 5-year follow-up than those with scores2.Level III-case-control study.

Research question What are the reproductive choices and retrospective reflections of women at least 4 years after planned oocyte cryopreservation (POC)? Design This was an internet survey, using the REDCap application, of women who underwent POC, at a single-centre university-affiliated IVF unit, 4–8 years before the survey. The questionnaire addressed reproductive choices and outcomes following POC. Results Seventy-nine women who underwent POC during 2011–2014 were invited to participate, and 70 (89%) responded. Mean age at cryopreservation was 37.1 ± 2.4 (range 30–41) years, mean age at study participation 42.6 ± 2.6 (range 35–48) years, and mean time from first cryopreservation cycle to study participation 5.5 ± 1.3 (range 4–8) years. The main retrospectively reported reason for POC was not wanting to become pregnant without a partner (59, 84%). During the follow-up period, 44 women (63%) attempted to conceive either naturally or by assisted reproductive technology using fresh or cryopreserved oocytes. Of those, 28 women achieved a live birth (64% of those who tried to conceive). Fourteen respondents (20% of all respondents) reported using their cryopreserved oocytes, and three (21%) achieved a birth using those oocytes. Fifteen women (34%) of those who tried to conceive used donor spermatozoa. Conclusions The most common reasons for not using frozen oocytes were achieving pregnancy without frozen oocytes or preferring not to have a child without a partner. A considerable proportion of women who had POC and were not interested in being a single parent by choice eventually try to conceive using donor spermatozoa several years later.

Esthetic demands for correction of irregularities of dentition are becoming a prime concern even in patients above the age of 40 years. Severe periodontitis, being insidious, if present simultaneously, complicates the situation. Periodontally compromised adult patients requiring the treatment for malaligned teeth are encountered very frequently in daily practice, and the correction of these requires a combined perio-ortho interdisciplinary approach. The present case report deals with a 5-year follow-up of a case whose prime concern was rotated anterior teeth in the maxillary arch. However, along with this, severe periodontitis was also present. Open flap debridement along with osseous grafting was done wherever required, followed by fixed adjunctive orthodontic treatment. After the completion of orthodontic treatment, a fixed retainer in the form of splinting was given and the entire treatment met the esthetic along with functional demands of the patient. Early 6 months followed by yearly follow-ups reflected clinical and radiographic improvements in the dentition.

Background: High-level athletes (HLAs) have been shown to have better short-term outcomes than nonathletes (NAs) after hip arthroscopy. Purpose: (1) To report midterm outcomes of HLAs after primary hip arthroscopy and (2) to compare their results with a propensity-matched cohort of NA patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed between February 2008 and November 2015 for HLAs (professional, college, or high school) who underwent primary hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS). HLAs were included if they had preoperative, minimum 2-year, and minimum 5-year follow-up data for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score Sports-Specific Subscale (HOS-SSS). Radiographic and intraoperative findings, surgical procedures, patient-reported outcomes (PROs), patient acceptable symptomatic state (PASS), minimal clinically important difference (MCID), and return to sport were reported. The HLA study group was propensity-matched to a control group of NA patients for comparison. Results: A total 65 HLA patients (67 hips) were included in the final analysis with mean follow-up time of 74.6 ± 16.7 months. HLAs showed significant improvement in all PROs recorded, achieved high rates of MCID and PASS for mHHS (74.6% and 79.4%, respectively) and HOS-SSS (67.7% and 66.1%, respectively), and returned to sport at high rates (80.4%). When compared with the propensity-matched NA control group, HLAs reported higher baseline but comparable postoperative scores for the mHHS and NAHS. HLA patients achieved MCID and PASS for mHHS at similar rates as NA patients, but the HLA patients achieved PASS for HOS-SSS at higher rates that trended toward statistical significance (66.1% vs 48.4%; P = .07). NA patients underwent revision arthroscopic surgery at similar rates as HLA patients (14.9% vs 9.0%, respectively; P = .424). Conclusion: Primary hip arthroscopy results in favorable midterm outcomes in HLAs. When compared with a propensity-matched NA control group, HLAs demonstrated a tendency toward higher rates of achieving PASS for HOS-SSS but similar arthroscopic revision rates at minimum 5-year follow-up.

Background This study aimed to identify risk factors for chronic syndesmotic instability following syndesmotic fixation. Methods We performed a retrospective review of consecutive patients who had sustained ankle fractures requiring syndesmotic fixation. Patients available for a minimum 5 years of follow-up were classified into 2 groups according to the presence of syndesmotic instability. Statistical binary logistic regression analyses were performed to investigate the significance of various risk factors. Functional outcomes were assessed using the FAOS. Results In total, 166 patients who met the study inclusion criteria underwent analysis. The overall postoperative instability rate was 20.5%, which was significantly affected due to BMI (p = 0.018; OR 6.72), and concomitant posterior malleolar fracture (p = 0.032, OR 2.77). The mean scores in the syndesmotic instability (SI) group were significantly lower than those in the no syndesmotic instability (NSI) group (p = 0.021). Conclusions Obesity and concomitant posterior malleolar fracture were significant risk factors for postoperative syndesmotic instability.

Barrier membranes are critical to the success of guided bone regeneration (GBR). Though not directly involved in bone regeneration, barrier membranes hold bone graft materials at the surgical site during the slow process of bone regeneration and prevent the infiltration of fibrotic gingival tissues that would compromise new bone formation. Many options are available on the market, but membranes derived from placental tissues are gaining rapid adoption due to their unique biologic and handling properties. In this case series, a dehydrated human deepithelialized amnion-chorion membrane (ddACM) was used in combination with freeze-dried bone allograft (FDBA) for two-stage GBR procedures. Data from 1-year and 5-year follow-up appointments are presented, as well as predictable indications for the use of ddACM. Using ddACM with FDBA for GBR cases led to predictable bone regeneration with osseointegrated implants at 5-year postoperative visits.

Guided tissue regeneration (GTR) has been proven to promote attachment and regeneration of periodontal tissue. However, there is a 20 to 40% incidence of attachment loss on regenerated attachments reported in the literature. To my knowledge, this is the first case report on a second attempt in GTR on a previous successful grafted site with clinical attachment loss. A healthy 17-year-old Chinese male patient had GTR performed with xenograft particles and bovine resorbable membrane on his root-canal treated, fused upper right lateral incisor and upper right canine (#12-#13) in 2007. Probing depth on the mid-palatal region of #12-#13 was reduced to 4 mm and maintained for the next 4 years. But in the fifth year, probing depth increased to 11 mm with no endodontic symptoms, and a second attempt of GTR using the same materials was carried out. The probing depth at the surgical site was reduced to 4 mm and successfully maintained for another 5 years. Irregular maintenance and the presence of plaque retentive factor could have caused the clinical attachment loss on #12-#13. This case shows it is possible to attempt GTR on a previous successfully grafted site. GTR did not increase tissue resistance against periodontal breakdown. Hence, proper maintenance planning for GTR sites is important to prevent periodontal breakdown.

Purpose The aim of this retrospective analysis is to estimate the most appropriate single cycle and cumulative doses of 225Ac-DOTATOC in patients treated for somatostatin-receptor-expressing cancers. Methods 225Ac-DOTATOC was administered to thirty-nine patients with various somatostatin-receptor-positive tumors. Baseline and follow-up 68Ga-DOTATOC PET/CT, lab tests, and renal scintigraphy were obtained. Patients received long-term follow-up either at the local cancer center or in close collaboration with external oncologists. Acute and chronic hematological toxicity was evaluated quantitatively over time. Long-term follow-up of creatinine was used to approximate the annual loss of estimated GFR (eGFR). Results Dose-dependent acute hematological toxicity was seen at single doses above 40 MBq or repeated doses greater than approximately 20 MBq 225Ac-DOTATOC at 4 month intervals. Treatment-related kidney failure occurred in 2 patients after a delay of >4 years but was independent of administered radioactivity, and other clinical risk factors were important contributors to renal decline. In general, the annual decline of eGFR among patients did not follow a clear dose-effect relationship even in patients with previous β-therapy. An average eGFR-loss of 8.4ml/min (9.9%) per year was observed which is similar to the experience with β-therapy studies. Conclusion Treatment activities of approx. 20 MBq per cycle (4 monthly repetition) and cumulative doses up to 60–80 MBq generally avoided both acute and chronic grade 3/4 hematotoxicity in patients with advanced stage malignancies. Chronic renal toxicity was observed at these doses, but pre-existing renal risk factors were important co-factors. These data represent a starting point for additional research to more precisely define safety thresholds of 225Ac-DOTATOC.

BackgroundVaccination against Streptococcus pneumoniae is among the most effective measures for preventing pneumonia and reducing the rate of chronic obstructive pulmonary disease (COPD) exacerbations. The objective of this work was to evaluate the long-term effectiveness of PCV13 and PPV23 for preventing pneumonia and COPD exacerbations.MethodsThe open-label, prospective, observational cohort study involved 302 male patients aged ≥45 years: PCV13 group (n=123); PPV23 group (n=32); and vaccine-naïve group (n=147). The primary endpoint included the frequency of pneumonia episodes and COPD exacerbations per year over a 5-year follow-up period. The secondary endpoints included the dynamics of dyspnea severity (MMRC), the BODE index, FEV1, the CAT index, the SGRQ score, and the results of 6-min walk test.ResultsVaccination with PCV13 and PPV23 significantly reduces the total rate of pneumonia during the first year after vaccination. Starting with the second year, clinical effectiveness in PPV23 group decreases compared with both PCV13 group and vaccine-naïve patients. Pneumonia by year 5 after vaccination were registered in versus 47% of patients in the PPV23 group 3.3% of patients in the PCV13 group (ppConclusionAlthough both vaccines have comparable clinical effects during the first year after vaccination, only PCV13 is characterized by persistent clinical effectiveness during the 5-year follow-up period. Patients older than 55 years on PPV23 have significantly higher risks of having pneumonia episodes more frequently during the long-term follow-up.

Background: Brain functional connectivity (FC) in multiple sclerosis (MS) is abnormal compared to healthy controls (HCs). More longitudinal studies in MS are needed to evaluate whether FC stability is clinically relevant. Objective: To compare functional magnetic resonance imaging (fMRI)-based FC between MS and HC, and to determine the relationship between longitudinal FC changes and structural brain damage, cognitive performance and physical disability. Methods: T1-weighted MPRAGE and resting-state fMRI (1.5T) were acquired from 70 relapsing-remitting MS patients and 94 matched HC at baseline (mean months since diagnosis 14.0 ± 11) and from 60 MS patients after 5 years. Independent component analysis and network modelling were used to measure longitudinal FC stability and cross-sectional comparisons with HC. Linear mixed models, adjusted for age and sex, were used to calculate correlations. Results: At baseline, patients with MS showed FC abnormalities both within networks and in single connections compared to HC. Longitudinal analyses revealed functional stability and no significant relationships with clinical disability, cognitive performance, lesion or brain volume. Conclusion: FC abnormalities occur already at the first decade of MS, yet we found no relevant clinical correlations for these network deviations. Future large-scale longitudinal fMRI studies across a range of MS subtypes and outcomes are required.

To report the minimum 5-year outcome after hip arthroscopy with labral repair in adolescents. From 2011 to 2014, 29 consecutive patients with a mean age 16.3 years (range 12.7–19.8 years) underwent hip arthroscopy treatment for femoroacetabular impingement syndrome. Patient-related outcome measures (PROMs) including modified Harris Hip Score (mHHS), Visual Analog Scale (VAS) for pain and Copenhagen Hip and Groin Outcome Score (HAGOS) were used preoperatively and at follow-up (FU). Percentage of patients achieving minimum clinically important difference (MCID) and substantial clinical benefit (SCB) for mHHS and HAGOS were determined. Mean FU was 6.7 years (range 5–9.6 years), and a 100% FU was accomplished. Significant improvements were seen for all PROMs at FU in patients not having a periacetabular osteotomy (PAO) with VAS pain score improving from mean 62 to 9, mHHS from 58 to 94 and HAGOS improved in all subgroups. For mHHS, SCB changes were achieved by 76% and MCID by 76% of the patients. Percentage of patients achieving MCID for HAGOS subgroups were 81% for pain, 67% for symptoms, 76% for physical function in daily living, 76% for physical function in sport and recreation, 81% for participation in physical activities and 81% for hip-related quality of life. Two patients had revision hip arthroscopy. PAO was later performed in three patients. The risk of further surgery with center edge (CE) bony edge (CEB)

Purpose The aim of this study was to compare straight and tapered implant designs in terms of marginal bone loss, the modified plaque index (mPI), and the modified bleeding index (mBI) for 5 years after functional loading. Methods Twelve patients were recruited. Two types of implants were placed adjacent to each other: 1 straight implant and 1 tapered implant. Marginal bone loss, mPI, and mBI were measured every year for 5 years after loading. Results The straight implants showed 0.2±0.4 mm of marginal bone loss at 5 years after loading, while the tapered implants showed 0.2±0.3 mm of marginal bone loss; this difference was not statistically significant (P=0.833). Our analysis also showed no statistically significant differences in mPI (straight implants: 0.3±0.3 vs. tapered implants: 0.2±0.3; P=0.414) or in mBI (straight implants: 0.3±0.4 vs. tapered implants: 0.2±0.3; P=0.317) at 5 years after prosthesis delivery. Conclusions Straight and tapered implants showed no significant differences with respect to marginal bone loss, mPI, and mBI for 5 years after loading., Graphical Abstract

BACKGROUND Keratosis pilaris is a hereditary abnormal keratosis of the hair follicle orifice. Gray-brown keratotic plugs in the pores and dark red keratotic papules at the openings of hair follicles can be seen, which contain coiled hair and are often accompanied by perifollicular erythema and pigmentation. Glycolic acid can correct the abnormalities of hair follicular duct keratosis and eliminate excessive accumulation of keratinocytes. It also promotes skin metabolism and accelerates the melanin metabolism. The therapeutic effect is related to the glycolic acid concentration. AIM To evaluate the efficacy and safety of a high concentration of glycolic acid in the treatment of keratosis pilaris, and to observe the outcomes at 5-year of follow-up. METHODS Twenty-five participants were recruited and areas with typical keratosis pilaris were selected as testing sites. High concentrations of glycolic acid (50% or 70%) were applied to a circular area (d = 8 cm, S = 50 cm2) and repeated four times, on days 0, 20, 40 and 60. Before each treatment and 20 d after the last treatment, on days 0, 20, 40, 60, and 80 and at a 5-year follow-up, The number of follicular keratotic papules were counted and the extent of perifollicular erythema and pigmentation was determined. At the same time, the participants provided subjective evaluations of treatment efficacy and safety. RESULTS Treatment effectiveness was indicated by the percentage of keratotic papules in the test site, on days 20, 40, 60 and 80, which were 8%, 12%, 36%, and 60%, respectively. Compared with day 0, each difference was significant (P < 0.05). Compared with day 0, differences in melanin content (M) in the skin and skin lightness (L) on days 40, 60 and 80, the were statistically significant (P < 0.05); skin hemoglobin content (E) on days 60 and 80 was statistically different as compared with before treatment (P < 0.05). There were no significant differences in the number of keratotic papules, M, L, and E in 9 participants at the 5-year follow-up compared with before treatment (P > 0.05%). CONCLUSION A high concentration of glycolic acid significantly improved skin roughness as well as follicular hyperpigmentation of patients with keratosis pilaris. The treatment was relatively safe, but there was no significant difference at the 5-year follow-up compared to before treatment.

Self-cutting is common among adolescents. However, studies examining protective factors are rare. It has been suggested that social support may protect against self-cutting in adolescence. The aim of this study was to investigate the possible association of social relationships with the initiation of self-cutting. Methods The participants were community-dwelling Finnish adolescents (N = 4171) aged 13-18 years at baseline. The follow-up assessment was conducted 5 years later (N = 794). Those adolescents who had self-cut before the baseline assessment (N = 134) were excluded from the analysis, leaving a total of 660 participants to be analyzed. In this group, 37 adolescents initiated self-cutting during the 5-year follow-up period and 623 did not. Cox's proportional hazards models were used with several adjustments for possible confounding factors. Findings A higher age, male gender, good relationships with siblings, weekly meetings with friends, and personal experience of not being lonely associated with the noninitiation of self-cutting during the follow-up period. Good relationships with parents or peers had no association with the initiation of self-cutting. Depressive symptoms mediated the effect of subjective loneliness on initiating self-cutting. Conclusions Social support produced by friends may have a protective effect against self-cutting.

BACKGROUND Dynamic cervical implant (DCI) stabilization has been reported to have satisfactory clinical and radiological results with short- and mid-term follow-up in the treatment of cervical degenerative disc disease. However, few reports about the clinical and radiological outcome with more than 5-year follow-up exist. AIM To investigate the long-term clinical and radiological results of DCI arthroplasty. METHODS A total of 40 patients who received DCI arthroplasty were consecutively reviewed from May 2010 to August 2015. Visual analogue scale (VAS), neck disability index (NDI) score, Japanese Orthopaedic Association (JOA) score, and SF-36 items were used to assess neural function rehabilitation. Static and dynamic radiographs and 3-dimentional computed tomography were used to evaluate the radiological outcomes. RESULTS The scores of neck/arm VAS, NDI, JOA, and 8-dimensions of SF-36 were significantly improved at the 1-mo follow-up (P < 0.05) and maintained until the last follow-up (P < 0.05). The range of motion (ROM) of C2-C7, functional spinal unit (FSU), upper/lower adjacent level, C2-C7 lateral bending, and FSU lateral bending decreased at the 1-mo follow-up (P < 0.05), whereas they increased to the preoperative level at the later follow-up intervals (P > 0.05), except the ROM of FSU lateral bending (P < 0.05). The C2-C7 alignment and FSU angle kept more lordotic at the last follow-up (P < 0.05). The intervertebral height increased significantly at the 1-mo follow-up (P < 0.05) and decreased at later follow-ups (P > 0.05). At the last follow-up, 12 (26.1%) segments developed heterotopic ossification. CONCLUSION DCI arthroplasty is a safe and effective non-fusion technique to treat cervical degenerative disc disease in long-term follow-up.

To (1) compare the rates of reaching threshold hip-specific outcome scores for achieving the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) in patients who underwent partial versus complete T-capsulotomy repair and (2) identify the failure rates in each group 5 years after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS).Data from consecutive patients who underwent hip arthroscopy for FAIS performed by a single fellowship-trained surgeon from January 2011 to March 2013 were collected and analyzed. Baseline data, hip-specific outcomes, and clinical failure rates were recorded at a minimum of 5 years postoperatively. Patients with partial T-capsulotomy repair were matched 1:3 by age, body mass index, and sex to patients with complete T-capsulotomy repair. Threshold scores for achieving the MCID and PASS were calculated and compared between the 2 groups. Additionally, rates of revision and conversion to total hip arthroplasty (THA) were compared between the groups.A total of 379 patients were available for analysis (39 partial and 340 complete repairs), with 100 patients included in the matching process (25 in the partial-repair group and 75 in the complete-repair group). Comparison of radiographic parameters, including the Tönnis grade, alpha angle, and lateral center-edge angle, between the 2 groups showed no statistically significant difference (P.05 for all). Comparison of postoperative score averages between the partial- and complete-closure groups showed a significant difference in the Hip Outcome Score-Activities of Daily Living Subscale (85.4 ± 17.7 vs 94.6 ± 7.8, P.001), Hip Outcome Score-Sports Subscale (76.6 ± 26.2 vs 89.3 ± 16.8, P = .034), modified Harris Hip Score (83.2 ± 19.7 vs 90.5 ± 11.2, P = .035), and visual analog scale pain score (24.5 ± 30.8 vs 13.4 ± 15.8, P = .035). A total of 65 complete-repair patients (95.6%) achieved the MCID for at least 1 outcome measure versus 18 patients with partial repair (78.3%) (P = .04). A total of 69 complete-repair patients (92%) achieved the PASS for at least 1 outcome measure versus 18 partial-repair patients (72%) (P = .017). Of the 39 partial-repair patients, 35.9% (n = 14) underwent revision or conversion to THA, as compared with 2.9% (n = 10) in the overall cohort.At a minimum 5-year follow-up, patients with complete capsular closure after hip arthroscopy for FAIS show superior long-term outcomes and achieve higher rates of meaningful clinical success when compared with patients with partial capsular closure. Furthermore, patients with partial capsular repair undergo revision or conversion to THA at high rates.Level III, retrospective comparative study.

Young patients are most susceptible to trauma which involves teeth and their supporting structures. Severity can vary from simple enamel fracture to complete tooth avulsion. The treatment modality ranges from a noninvasive procedure to surgical intervention. The present case report describes the unique management, 5-year follow-up, and prognosis of a 10-year-old child diagnosed with lateral luxation and horizontal apical root fracture of maxillary central incisor with open apex.

ObjectiveThis follow-up study on perceived self-image and psychophysical distress/psychic symptoms was based on a ranomized contolled study of art therapy on women with breast cancer.MethodThe aim was to examine the long-term effects of time-limited art therapy using the instruments of Structural Analysis of Social Behavior (SASB) and Symptom Check List-90 (SCL-90).ResultsThree attachment clusters of the SASB showed significant changes post therapy: Autonomous self (cluster 1), Accepting self (cluster 2), and Loving self (cluster 3). Clusters 2 and 3 continued to change in favor of the intervention group at the 5-year follow-up. There were no significant differences in the SCL-90 results between the intervention group and the control group in the follow-up study.Significance of resultsThe art therapy intervention was both therapeutic and psycho-educative. The conclusion of this study is that approaching emotions through time-limited art therapy seems to have a long-lasting effect on the attachment behavioral system shown in the SASB model post intervention, and this effect remained 5 years later.

BACKGROUND AND OBJECTIVE This study aimed to investigate if childhood primary snoring (PS) was associated with adverse cardiovascular outcomes at 5-year follow-up. METHODS This was a prospective matched cohort study. Subjects were recruited from a hospital-based cohort established from years 2006 to 2012 and they were aged 6-18 years at baseline. Each subject with PS was gender, age and BMI z-score matched with a control who had normal sleep study (obstructive apnoea-hypopnoea index [OAHI]

To compare outcomes of laparoscopic Roux-en-Y gastric bypass (LRYGB) versus laparoscopic sleeve gastrectomy (LSG) in patients with body mass index (BMI) ≥ 35 kg/m2 in terms of percent of excess weight lost (%EWL), percent of excess of body mass index lost (%EBMIL), postoperative complications, and resolution of comorbidities. A prospective and comparative study was carried out. Patients who met the inclusion criteria (200) were analyzed and assigned to two groups (LRYGB = 100 and LSG = 100), underwent surgery between 2012 and 2013, and followed up to 5 years. The mean follow-up was 66.5% (133 patients). Both groups were initially comparable in number of patients and age, not so in BMI and excess weight (p = 0.001). %EWL in LRYGB group was 76.3 ± 15.3, while in LSG group was 71.7 ± 21.9 with no significant difference (p = 0.172). Postoperative BMI was 27 ± 3.5 and 26.5 ± 5.1 kg/m2 for LRYGB and LSG, respectively, without significant difference (p = 0.527). Upper gastrointestinal bleeding was the most frequent complication in both groups, with no significant difference. Regarding resolution of comorbidities, hypertension remission was statistically significant in favor of LRYGB. No differences were found in the rest of comorbidities studied. The study showed successful %EWL, %EBMIL, and resolution of comorbidities, with very low morbidity and no mortality for both techniques. Only hypertension had significant better outcomes within LRYGB group. No clear advantage in any of these two procedures could be determined after 5 years of follow-up.

Aim: To evaluate the behavior of the alveolar ridge split technique in a series of surgical cases. Materials and Methods: One hundred and fifty implants were included in this study for a total of 60 patients. The surgeries consisted of a mid-crestal incision and subsequent bone management with a piezoelectric system. The implants were placed after the alveolar bone was expanded by about 3mm and present bony defects were filled by a mixture of 50% autogenous bone and a xenograft (Bio-Oss®). Bone fracture of the buccal alveolar plate occurred in 8 cases, and those were stabilized with osteosynthesis screws. Implants were simultaneously placed in 140 cases, out of them 4 failures occurred due to membrane exposition. Results: The osseointegration success was estimated to be 97.5%. Conclusion: This study concluded that the bone splitting/expansion seem to be a reliable, predictable, relatively noninvasive technique with limited intraoperative complications. Clinical significance: The study revealed that the alveolar ridge split can be used as an effective technique for atrophic edentulous maxillary and mandibular bone

Background: Previous studies have linked residential displacement as a result of the 2011 East Japan Earthquake to increases in body weight. However, no study has examined longer-term trajectories of body weight among displaced survivors. We compared body weight change between survivors relocated to temporary housing (TH) group versus other types of accommodation for up to 5 years after the Great East Japan Earthquake. Methods: Longitudinal follow-up was conducted from 2011 to 2015 in a cohort of 9,909 residents of 42,831. We compared trends in body weight in the TH group (n = 3,169) and the non-TH group (n = 6,740) using a mixed linear regression model stratified by sex (mean age, 61.0 years old; male, 38.9%). Results: In age-adjusted analysis, the body weight in the 2011 survey was not significantly different between two groups for either sex. In men, the TH group significantly increased body weight compared to the non-TH group since 2012. In women, body weight sharply increased in the TH group while body weight did not change in the non-TH group during survey time points. The interaction of living conditions and survey years was statistically significant in both sexes (men; F-value, 6.958; P < 0.001: women; F-value, 19.127; P < 0.001). Conclusion: Survivors relocated to temporary housing had an increased risk of weight gain. The weight gain in this group is a potential risk factor for metabolic syndrome in the post-disaster period.

Astroblastoma is a very rare glial tumor derived from astroblasts. It has been controversial in terms of its features and diagnosis. The objective of this report is to present the findings of the high-grade astroblastoma with a good prognosis in a 21-year-old female who presented to us with diplopia and headache. While imaging led to the foremost differentials of pleomorphic xanthoastrocytoma and Ganglioglioma which are low-grade neoplasms, the final diagnosis was established on microscopy and immunohistochemistry after excision. Treatment protocol included surgery with postoperative radiotherapy and chemotherapy. Due to controversial and limited literature, this tumor poses difficulties in diagnosis and management. This is a rare, successfully managed case of astroblastoma with a positive outcome 5 years after the diagnosis was established. In this case report, we review the steps of diagnosis, the differentials, the pathological and histological features, and the management of this rare entity.

Short root anomaly (SRA) is a rare dental condition with abnormally short and blunt root morphology. It mostly affects maxillary central incisors symmetrically and only has been observed in permanent teeth. A 9-year-old girl was referred from a local dental clinic for short root development in mixed dentition with no symptoms. Radiographic and intraoral examinations revealed SRA on upper and lower incisors and mandibular first molars along with other dental anomalies such as enamel hypoplasia and dens invaginatus. During long - term follow - up for 5 years, her mixed dentition has changed to permanent dentition and generalized SRA was observed in all permanent teeth. Cephalometric radiograph also revealed the calcification between the anterior and posterior clinoid processes described as a sella turcica bridge which was reported associating with dental anomalies. Early diagnosis of SRA is emphasized for successful management and prevention of root resorption and tooth loss. This report aimed to present a rare case of generalized SRA along with other dental anomalies and sella turcica bridging in a female patient through long - term follow - up.

Objectives: The Accreditation Council for Graduate Medical Education has guidelines on assessing surgical qualifications based on experience. Attending surgeons have various assumptions on how their trainees learn and acquire surgical skills. This study primarily investigates the resident’s perspective on gaining experience and achieving competency in thyroid surgical procedures. Methods: A qualitative study using semi-structured interviews was designed to derive themes that discuss the acquisition of competency in thyroid surgery. After IRB approval, data was collected from 2012 to 2014 at 4 academic centers in the Washington, DC area. Fourteen chief residents specializing in either general surgery or otolaryngology were interviewed until saturation was achieved. These semi-structured interviews were transcribed and broken up into codes utilizing Moustakas’ analysis. A comprehensive list of master themes in regards to achieving competency in thyroid surgery was developed. A follow up survey of the surgeons was undertaken at 5 years to determine if the perceptions during residency persisted in practice. Results: Surgical specialty residents experience and learn thyroid surgery in 5 learning themes: 1. Self—directed learning is significant during residency. 2. Repetition with graduated autonomy is key. 3. Effective mentors are competent surgeons who challenge residents and use positive teaching techniques. 4. Residents employ active learning through the “see one, do one, teach one” philosophy. 5. Learning from complexity is of importance to residency training. After several years in practice, the most important theme in learning after residency was repetition of cases. Conclusions: This study demonstrates how residents progress in approaching competency in thyroid surgery. Adult learning strategies are preferred, and programs should incorporate tailored techniques to meet the individual needs of the residents. Perceptions of what is most important shifted in long-term follow up. Further study is needed to assure competency in residency and in practice.

The use of robotics in bariatric surgery is increasing worldwide, with as main objective reducing complications and optimising surgical outcome. This study presents the results of a single surgeon 8-year experience with a totally robotic Roux-en-Y gastric bypass (RYGB).A total of 183 consecutive patients underwent a robotic bariatric procedure. A retrospective analysis was performed of all patient files to obtain patient characteristics, weight loss results and per- and postoperative morbidity. For long-term follow-up all patients were contacted one by one.In 155/183 patients, a primary RYGB was performed, 23 procedures were revisional cases and in 5 other procedures were performed. Mean initial weight was 112.07 (±20.5) kg, mean start BMI was 40.8 (±5.36) kg/mThe robotic RYGB is a safe and reproducible approach to treat morbid obesity. A secure hand-sewn gastrojejunal anastomosis, quick recovery and better ergonomics are the main advantages of this technique.

Introducao Os suportes coronarianos bioabsorviveis foram projetados para prevenir complicacoes em longo prazo relacionadas ao implante permanente de stents metalicos. O suporte vascular bioabsorvivel eluidor de everolimus (Absorb BVS; Abbott Vascular, Santa Clara, California) foi um dos primeiros suportes vasculares bioabsorviveis (BVS, do ingles bioresorbable vascular scaffold) a ser desenvolvido. O BVS Absorb e uma estrutura feita de acido poli-L-lactico revestido com polimero poli-DL-lactico, que elui o farmaco antiproliferativo everolimus. O BVS recebeu a marca CE para o tratamento de [...]

Background: An accurate identification of older individuals at increased risk of developing dementia is very important. Various dementia risk prediction models have been developed, but not all models are applicable among older population. Objectives: To examine the association of the Brief Dementia Risk Index (BDRI) and incidence of dementia among community-dwelling Finnish older adults. Methods: Participants were community-dwelling nondemented 70-year-olds examined in 2011 (n = 943). Cox regression model with death as a competing risk was used to analyze the association of BDRI and incident dementia (ICD-10 codes F00-03 and G30) during the 5-year follow-up (n = 883). Results: The rate of dementia incidence was 4.9% during the follow-up. Having at least moderate risk according to BDRI significantly predicted incident dementia (hazard ratio 3.18, 95% confidence interval: 1.71–5.92, p < 0.001), also after adjustment with education level (2.93, 1.52–5.64, p = 0.001). No interaction between gender and BDRI was found. Conclusion: BDRI could be an applicable tool for identification of older individuals at increased risk of developing dementia in clinical settings.

Aim:Despite advances in-stent technology, in-stent restenosis (ISR) is still a major problem following percutaneous coronary intervention (PCI) and its reasons have not been fully revealed. In the presented study, we investigated the effect of admission blood glucose (ABG), fasting blood glucose (FBG) and glycated hemoglobin A1c (HbA1c) levels on coronary ISR patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI in five-year follow-up.Methods:From 2.900 patients who underwent coronary stent implantation for STEMI from January 2008 through December 2012 were retrospectively analyzed through the hospital digital recording system. Of these, 264 patients who underwent control coronary angiography during the five-year follow-up were included in the study. Patients were divided into two main group ISR and non-ISR; were divided into two subgroups diabetic and non-diabetic groups were compared with HbA1c, ABG, FBG and angiographic parameters.Results:There were 127 patients in the ISR group (diabetic: 36 non-diabetic: 91) and 137 patients in the non-ISR group (diabetic: 43 non-diabetic: 94). Regardless of the patients diabetes status, no significant difference was found between the groups with and without ISR in terms of HbA1c, FBG and ABG. A significant relationship was found between the baseline HbA1c value and having ISR only in the diabetic subgroup (p=0.01).Conclusion:This study results showed that in diabetic STEMI patients who underwent primary PCI, higher HbA1c levels were associated with higher ISR rates, but not with FBG and ABG levels.

Objective The surgical approach for cervical spondylotic radiculopathy (CSR) is controversial. This study aims to investigate the effectiveness of the combined anterior cervical diskectomy and fusion (ACDF) and uncovertebrectomy for treatment of CSR. Methods This is a retrospective case control study. One hundred and forty-six patients with CSR who underwent two different procedures (ACDF alone [group A]) and a combination of ACDF and uncovertebrectomy [group B]) from March 2008 to April 2013 were included. The operation time, blood loss, Visual Analog Scale scores of the neck (VAS-neck) and arm (VAS-arm), Neck Disability Index (NDI) score, 36-Item Short Form Health Survey (SF-36) score, fusion segment curvature, global cervical curvature, and the rate of surgical complication were evaluated. Results There were no significant differences in the basic demographic and clinical characteristics between the two groups (p > 0.05). No significant differences were noticed in the fusion segment curvature and global cervical curvature between the two groups (p > 0.05). Whereas the operation time and blood loss in group B were greater than those in group A (p 0.05). Conclusions Clinical efficacy of ACDF plus uncovertebrectomy for the treatment of patients with CSR may be better than that of ACDF alone, but at the expense of more operation time and blood loss.

Purpose This study aimed to analyze technical and clinical factors related to oncological outcomes in patients with localized prostate cancer (PC) who were treated with whole-gland high-intensity focused ultrasound (HIFU). Materials and Methods From 2007–2014, patients diagnosed with localized PC who underwent whole-gland HIFU were consecutively included retrospectively. Biochemical failure was defined according to the Phoenix ASTRO guidelines. The relationship between oncological outcomes and technical and clinical factors was evaluated. Results The study cohort included 428 patients. The median age was 67 years, and the median prostate-specific antigen level was 7.61 ng/mL. Patient risk classifications were low (n = 102), intermediate (n = 240), and high (n = 86). Biochemical disease-free survival rates of patients with HIFU for localized PC in the total, low-, intermediate-, and high-risk groups according to D’Amico risk groups over a median follow-up period of 5 years (range 9-144) were 68.4%, 80.4%, 65.6%, and 61.6%, respectively. In multivariate logistic regression analyses to predict biochemical failure of the treatment, neoadjuvant hormonal therapy (NHT) in the high-risk group (OR 0.225, p = 0.015), and compression method in the low- (OR 0.178, p = 0.030), intermediate- (OR0.291, p

Objective: To analyze outcomes of hallux valgus surgical correction using the Reverdin-Isham technique by means of clinical and radiographic studies. Methods: We retrospectively assessed 43 feet (38 patients) with moderate to severe hallux valgus treated from June 2009 to July 2014. Mean age at surgery was 59 years; mean postoperative follow-up time was 79 months. Patients were assessed at pre- and postoperative periods both functionally, by the American Orthopaedic Foot and Ankle Society (AOFAS) score, and radiographically, by the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and shortening of 1st metatarsal bone. Results: AOFAS scores had a mean increase of 55 points. Mean HVA decreased 14.5°, whereas IMA and DMAA exhibited a mean decrease of 3.8° and 9.7°, respectively. Mean shortening of the first metatarsal bone was 3mm. Conclusion: The presented surgical technique showed to be effective to correct mild to moderate hallux valgus, resulting in appropriate angle correction angular and significant increase in AOFAS scores. Level of Evidence IV; Therapeutic Studies; Case Series.

Detailed treatment planning and execution are crucial if regenerative approaches are to be attempted to retain fused permanent teeth. Long‐term follow‐up is necessary to monitor the stability of the final outcome, both esthetically and functionally., Detailed treatment planning and execution are crucial if regenerative approaches are to be attempted to retain fused permanent teeth. Long‐term follow‐up is necessary to monitor the stability of the final outcome both esthetically and functionally.

Background In case of isolated medial and patellofemoral joint arthritis, bicompartmental knee arthroplasty (BCA) is an alternative to total knee arthroplasty (TKA). The purpose of our prospective, randomized study is to compare the clinical outcome of BCA vs TKA. Methods Eighty patients with isolated medial and patellofemoral osteoarthritis were randomly assigned to either BCA or TKA. Patients were evaluated preoperatively, 3, 6, and 12 months, and 2 and 5 years after the procedure. Knee Society Score, Oxford Knee Score, and the University of California,Los Angeles activity scores were calculated at each follow-up; Forgotten Joint Score was assessed at final follow-up. Results There was an improvement in Knee Society Score, Oxford Knee Score, and the University of California,Los Angeles scores in both groups but no significant differences between both groups at any follow-up. The Forgotten Joint Score at 5-year follow-up was not significantly different either. Range of motion was significantly greater in the BCA group from 1-year follow-up onward. Conclusion Our study did not show significant differences in clinical scores between BCA and TKA; only range of motion was significantly greater in BCA. Therefore, it is questionable whether this difference justifies the complexity of BCA associated with higher risk of failure. Maybe staged patellofemoral joint arthroplasty in the presence of a well-functioning UKA is an option for BCA and an alternative to revision to TKA. Long-term studies are needed to explore the potential benefits of BCA.

Study Design: Prospective follow-up study. Objectives: We aimed to assess the effect of lumbar spine fusion (LSF) on disability, health-related quality of life and mortality in a 5-year follow-up, and to compare these results with the general population. Methods: 523 consecutive LSF operations were included in a prospective follow-up. Disability was assessed by the Oswestry Disability Index (ODI), and HRQoL by the 36-item Short Form (SF-36) questionnaire using the physical and mental summary scores (PCS and MCS). The patients were compared with an age-, sex-, and residential area matched general population cohort. Results: The preoperative ODI in the patients was 46 (SD 16), and the change at 5 years was −26 (95% CI: −24 to −28), p < 0.001. In the population, ODI (baseline 13, SD 16) remained unchanged. The preoperative PCS in the patients was 27 (SD 7), in the population 45 (SD 11), and the increase in the patients at 5 years was 8 (95% CI: 7 to 9), p < 0.001. The patients did not reach the population in ODI or PCS. The baseline MCS in the patients was 47 (SD 13), and the change at 5 years 4 (95% CI: 3 to 7), p < 0.001. MCS of the females reached the population at 5-year follow-up. When analyzing short and long fusions separately, comparable changes were seen in both subgroups. There was no difference in mortality between the patients (3.4%) and the population (4.8%), hazard ratio (HR) 0.86. Conclusions: Although the patients who had undergone LSF benefited from surgery still at 5 years, they never reached the physical level of the population.

A well-fixed cement–bone interface is a crucial factor for acetabular and femoral components in cemented total hip arthroplasty (THA). The aim of the present study was to evaluate the middle-term clinical and radiological results of fixing the acetabular component with an interface bioactive bone cement (IBBC) technique in primary cemented THA. We undertook a retrospective review was undertaken of 193 primary cemented THAs in 174 patients using acetabular components cemented with an IBBC technique and followed for a minimum of 5 years (mean 8.3 years; range 5–17 years). Baseline data, clinical and radiological outcomes were evaluated. Japanese Orthopedic Association hip score and modified Harris hip scores demonstrated significant clinical improvement in all patients (p

Objectives Following an exploratory approach, we examined cardiovascular disease risk factors at baseline and the 5-year incidence proportion of self-reported doctor-diagnosed cardiovascular diseases (CVD) in teachers and other occupational groups of the Gutenberg Health Study. Methods Study participants lived in the region of Mainz, Germany. Data from 6510 working participants without prevalent CVD at baseline (2007–2012) were analyzed. Participants were teachers (n = 215), other professionals from the health, social or educational (HSE) fields (n = 1061) or worked outside the HSE fields (n = 5234). For occupational comparisons, we estimated prevalence ratios (PR) for each CVD risk factor at baseline with robust Poisson regression analyses. We calculated crude CVD incidence rates based on the observed 5-year CVD cumulative incidence at follow-up and estimated age-weighted incidence proportions. All analyses were stratified by sex. Results Male non-HSE workers showed a higher prevalence of smoking and physical inactivity than male teachers (PR 2.26; 95%-CI: 1.06–4.82/PR 1.89; 95%-CI: 1.24–2.87). In contrast, non-HSE workers and other HSE professionals were less likely to have reported an unhealthy alcohol intake than teachers. Differences were attenuated after SES-adjustment. We did not detect occupational group-specific differences in CVD incidence. However, there were only two cases of CVD among the teachers. Conclusion Particularly male teachers showed a healthier lifestyle regarding physical inactivity and smoking. Nevertheless, occupational-medical care practitioners and researchers need to be aware of the relatively heightened prevalence of unhealthy alcohol intake in female and male teachers, and in absolute terms, the high hypertension prevalence in male teachers.

Purpose The aim of this study was to (1) investigate whether radiographic and clinical parameters, which influence how stresses during sporting activities act on the proximal femur, are associated with cam morphology or (2) precede cam morphology development. Methods Young male football players participated at baseline (n = 89, 12–19 years of age), 2.5-year (n = 63) and 5-year follow-up (n = 49). Standardized anteroposterior pelvic and frog-leg lateral radiographs were obtained at each time-point. Cam morphology was quantified by an alpha angle ≥ 60°, and large cam morphology ≥ 78°. The neck–shaft angle (NSA), epiphyseal extension (EE), lateral center–edge angle (LCEA) and hip internal rotation (IR) were also measured. Cross-sectional associations between NSA, EE, LCEA and IR and (large) cam morphology were studied at all time-points. To study whether these variables preceded cam morphology development, hips without cam morphology at baseline were studied prospectively. Results A lower NSA, a higher EE and limited IR were consistently associated with cam morphology at all three time-points. These differences were more pronounced in hips with large cam morphology. No association between cam morphology and the LCEA was found. None of the parameters studied preceded cam morphology development. Conclusion Cam morphology developed simultaneously with a varus orientation, growth plate extension towards the femoral neck and limited hip internal rotation. These parameters did not precede cam morphology development. The hip parameters studied cannot be used to identify individuals at risk of developing cam morphology. Level of Evidence: Level II.

Background/AimsTo investigate clinical characteristics and risk factors for glaucoma conversion of the contralateral eye in unilateral normal-tension glaucoma (NTG) patients.MethodsA retrospective observational cohort study was conducted on a total of 76 subjects who had been diagnosed with unilateral NTG at the baseline and followed up for more than 5 years. Glaucoma conversion in the contralateral eye was defined as increased thinning of neuro-retinal rim, development of retinal nerve fibre layer defect and/or development of glaucomatous visual field defect.ResultsDuring the mean follow-up period of 7.3±2.4 years, 21 of 76 (27.6%) subjects were confirmed to have developed glaucoma in the non-glaucomatous contralateral eye. The 5-year rate of glaucoma conversion in contralateral eyes was 19.7%. The maximum width of β-zone parapapillary atrophy (MWβPPA)-disc diameter (DD) ratio at the baseline and the presence rate of disc haemorrhage during follow-up period were significantly greater in the contralateral eyes of the conversion group than in those of the non-conversion group (p=0.011, ConclusionsAmong unilateral NTG patients, those with low CCT and high MWβPPA-DD ratio as well as high IOP in the contralateral eye are more likely to develop glaucoma in that eye during long-term follow-up.

The objective of this study was to examine the association between preoperative meniscal extrusion of patients undergoing partial medial meniscectomy with clinical outcomes and progression of osteoarthritis and to determine the extent of meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis. Ninety-five patients who underwent partial medial meniscectomy with a minimum follow-up of 5 years were retrospectively reviewed. Preoperative meniscal extrusion was evaluated with magnetic resonance imaging. Patients were assessed preoperatively and postoperatively with Lysholm and International Knee Documentation Committee (IKDC) subjective scores for clinical outcomes and with IKDC radiographic scale for osteoarthritis. An ANOVA (Analysis of Variance) was used to analyze the variations in meniscal extrusion and the clinical and radiological outcomes. A regression analysis was performed to identify factors that affect preoperative medial meniscus extrusion and that influence results after partial meniscectomy. An optimal cutoff value for meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis was established. Significance was set at p

Background The selection of the lowest instrumented vertebra (LIV) in patients with adolescent idiopathic scoliosis (AIS) is still controversial. Although multiple radiographic methods have been proposed, there is no universally accepted guideline for appropriate selection of the LIV. We developed a simple and reproducible method for selection of the LIV in patients with Lenke type-1 (main thoracic) and 2 (double thoracic) curves and investigated its effectiveness in producing optimal positioning of the LIV at 5 years of follow-up. Methods The radiographs for 299 patients with Lenke type-1 or 2 AIS curves that were included in a multicenter database were evaluated after a minimum duration of follow-up of 5 years. The "touched vertebra" (TV) was selected on preoperative radiographs by 2 independent examiners. The LIV on postoperative radiographs was compared with the preoperative TV. The final LIV position in relation to the center sacral vertical line (CSVL) was assessed. The CSVL-LIV distance and coronal balance in patients who had fusion to the TV were compared with those in patients who had fusion cephalad and caudad to the TV. The sagittal plane was also reviewed. Results In 86.6% of patients, the LIV was selected at or immediately adjacent to the TV. Among patients with an "A" lumbar modifier, those who had fusion cephalad to the TV had a significantly greater CSVL-LIV distance than those who had fusion to the TV (p = 0.006) or caudad to the TV (p = 0.002). In the groups with "B" (p = 0.424) and "C" (p = 0.326) lumbar modifiers, there were no differences among the TV groups. Conclusions We recommend the TV rule as a third modifier in the Lenke AIS classification system. Selecting the TV as the LIV in patients with Lenke type-1 and 2 curves provides acceptable positioning of the LIV at long-term follow-up. The position of the LIV was not different when fusion was performed caudad to the TV but came at the expense of fewer motion segments. Patients with lumbar modifier "A" who had fusion cephalad to the TV had greater translation of the LIV, putting these patients at risk for poor long-term outcomes. Level of evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.