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Understanding the changes in running mechanics caused by fatigue is essential to assess its impact on athletic performance. Changes in running biomechanics after constant speed conditions are well documented, but the adaptive responses after a maximal incremental test are unknown. We compared the spatiotemporal, joint kinematics, elastic mechanism, and external work parameters before and after a maximal incremental treadmill test. Eighteen recreational runners performed 2-minute runs at 8 km·h−1 before and after a maximal incremental test on a treadmill. Kinematics, elastic parameters, and external work were determined using the OpenCap and OpenSim software. We did not find differences in spatiotemporal parameters and elastic parameters (mechanical work, ankle, and knee motion range) between premaximal and postmaximal test conditions. After the maximal test, the runners flexed their hips more at contact time (19.4°–20.6°, P =.013) and presented a larger range of pelvis rotation at the frontal plane (10.3°–11.4°, P =.002). The fatigue applied in the test directly affects pelvic movements; however, it does not change the lower limb motion or the spatiotemporal and mechanical work parameters in recreational runners. A larger frontal plane motion of the pelvis deserves attention due to biomechanical risk factors associated with injuries. [ABSTRACT FROM AUTHOR]

PURPOSE: To assess the effect of various pelvic fixation techniques and number of rods on biomechanics of the proximal junction of long thoracolumbar posterior instrumented fusions. METHODS: A validated spinopelvic finite-element (FE) model was instrumented with L5-S1 ALIF and one of the following 9 posterior instrumentation configurations: (A) one traditional iliac screw bilaterally (2 Iliac/2 Rods); (B) T10 to S1 (Sacral Only); (C) unilateral traditional iliac screw (1 Iliac/2 Rods); (D) one traditional iliac screw bilaterally with one midline accessory rod (2 Iliac/3 rods); (E) S2AI screws connected directly to the midline rods (2 S2AI/2 Rods); and two traditional iliac screws bilaterally with two lateral accessory rods connected to the main rods at varying locations (F1: T10-11, F2: T11-12, F3: T12-L1, F4: L1-2) (4 Iliac/4 Rods). Range of motions (ROM) at T10-S1 and T9-T10 were recorded and compared between models. The T9-T10 intradiscal pressures and stresses of the T9-10 discs annulus in addition to the von Mises stresses of the T9 and T10 vertebral bodies were recorded and compared. RESULTS: For T10-S1 ROM, 4 iliac/4 rods had lowest ROM in flexion and extension, while 2 S2AI/2 rods showed lowest ROM in rotation. Constructs with 3 or 4 rods had lower stresses on the primary rods compared to 2-rod constructs. At the proximal adjacent disc (T9-10), 4 iliac/4 rods showed lowest ROM, lowest intradiscal pressures, and lowest annular stress in all directions (most pronounced in flexion-extension). Under flexion and extension, 4 iliac/4 rods also showed the lowest von Mises stresses on the T10 vertebral body but the highest stresses on the T9 vertebral body. CONCLUSIONS: Dual iliac screws with 4 rods across the lumbosacral junction and extending to the thoracolumbar junction demonstrated the lowest T10-S1 ROM, the lowest adjacent segment disc (T9-T10) ROM, intradiscal pressures, and annular stresses, and the lowest UIV stresses, albeit with the highest UIV + 1 stresses. Additional studies are needed to confirm whether these biomechanical findings dictate clinical outcomes and effect rates of proximal junctional kyphosis and failure.

STUDY DESIGN: Retrospective review of prospective database. OBJECTIVES: Vertebral pelvic angles (VPAs) account for complexity in spine shape by assessing the relative position of each vertebra with regard to the pelvis. This study uses VPAs to investigate the shape of the fused spine after T10-pelvis fusion, in patients with adult spinal deformity (ASD), and then explores its association with proximal junctional kyphosis (PJK). METHODS: Included patients had radiographic evidence of ASD and underwent T10-pelvis realignment. VPAs were used to construct a virtual shape of the post-operative spine. VPA-predicted and actual shapes were then compared between patients with and without PJK. Logistic regression was used to identify components of the VPA-based model that were independent predictors of PJK occurrence and post-operative shape. RESULTS: 287 patients were included. VPA-predicted shape was representative of the true post-operative contour, with a mean point-to-point error of 1.6-2.9% of the T10-S1 spine length. At 6-weeks follow-up, 102 patients (35.5%) developed PJK. Comparison of the true post-operative shapes demonstrated that PJK patients had more posteriorly translated vertebrae from L3 to T7 (P < .001). Logistic regression demonstrated that L3PA (P = .047) and T11PA (P < .001) were the best independent predictors of PJK and were, in conjunction with pelvic incidence, sufficient to reproduce the actual spinal contour (error

Gait asymmetry is a predictor of fall risk and may contribute to increased falls during pregnancy. Previous work indicates that pregnant women experience asymmetric joint laxity and pelvic tilt during standing and asymmetric joint moments and angles during walking. How these changes translate to other measures of gait asymmetry remains unclear. Thus, the purpose of this case study was to determine the relationships between pregnancy progression, subsequent pregnancies, and gait asymmetry. Walking data were collected from an individual during 2 consecutive pregnancies during the second and third trimesters and 6 months postpartum of her first pregnancy and the first, second, and third trimesters and 6 months postpartum of her second pregnancy. Existing asymmetries in step length, anterior–posterior (AP) impulses, AP peak ground reaction forces, lateral impulses, and joint work systematically increased as her pregnancy progressed. These changes in asymmetry may be attributed to pelvic asymmetry, leading to asymmetric hip flexor and extensor length, or due to asymmetric plantar flexor strength, as suggested by her ankle work asymmetry. Relative to her first pregnancy, she had greater asymmetry in step length, step width, braking AP impulse, propulsive AP impulse, and peak braking AP ground reaction force during her second pregnancy, which may have resulted from increased joint laxity. [ABSTRACT FROM AUTHOR]

PURPOSE: To define the prevalence, characteristics, and treatment approach for proximal junction failure secondary to odontoid fractures in patients with prior C2-pelvis posterior instrumented fusions (PSF). METHODS: A single institutions database was queried for multi-level fusions (6+ levels), including a cervical component. Posterior instrumentation from C2-pelvis and minimum 6-month follow-up was inclusion criteria. Patients who sustained dens fractures were identified; each fracture was subdivided based on Anderson & DAlonzo and Grauers classifications. Comparisons between the groups were performed using Chi-square and T tests. RESULTS: 80 patients (71.3% female; average age 68.1 ± 8.1 years; 45.0% osteoporosis) were included. Average follow-up was 59.8 ± 42.7 months. Six patients (7.5%) suffered an odontoid fracture post-operatively. Cause of fracture in all patients was a mechanical fall. Average time to fracture was 23 ± 23.1 months. Average follow-up after initiation of fracture management was 5.84 ± 4 years (minimum 1 year). Three patients sustained type IIA fractures one of which had a concomitant unilateral C2 pars fracture. Three patients sustained comminuted type III fractures with concomitant unilateral C2 pars fractures. Initial treatment included operative care in 2 patients, and an attempt at non-operative care in 4. Non-operative care failed in 75% of patients who ultimately required revision with proximal extension. All patients with a concomitant pars fracture had failure of non-operative care. Patients with an intact pars were more stable, but 50% required revision for pain. CONCLUSIONS: In this 11-year experience at a single institution, the prevalence of odontoid fractures above a C2-pelvis PSF was 7.5%. Fracture morphology varied, but 50% were complex, comminuted C2 body fractures with concomitant pars fractures. While nonoperative management may be suitable for type II fractures with simple patterns, more complex and unstable fractures likely benefit from upfront surgical intervention to prevent fracture displacement and neural compression. As all fractures occurred secondary to a mechanical fall, inpatient and community measures aimed to minimize risk and prevent mechanical falls would be beneficial in this high-risk group.

PURPOSE: To present a case of a pseudoaneurysm of a branch of the left superior gluteal artery (SGA) secondary to lateral wall perforation from an iliac screw and its subsequent evaluation and management. METHODS: Case report. RESULTS: A 67-year-old female with a history of degenerative flatback and scoliosis and pathological fractures of T12 and L1 secondary to osteodisciitis underwent a single0stage L5-S1 ALIF and T9-pelvis posterior instrumented fusion with bilateral dual iliac screw fixation, revision T11-S1 decompression, and T12 and L1 irrigation and debridement and partial corpectomies. During the operation, non-pulsatile bleeding was encountered after creating an initial trajectory for the more proximal of the two left iliac screws. While the initial post-operative course was benign, the patient was readmitted for hypotension and anemia. Computed tomography of the abdomen/pelvis demonstrated a pseudoaneurysm (2.3 cm × 2.1 cm × 2.3 cm) of a branch of the left SGA. Diagnostic angiogram confirmed a pseudoaneurysm off of one of the branches of the left SGA. Endovascular embolization using multiple coils resulted in a complete cessation of blood flow in the pseudoaneurysm. At 2 years follow-up, no symptoms suggestive of recurrence of the pseudoaneurysm were reported. CONCLUSIONS: A pseudoaneurysm of a branch of the left superior gluteal artery as a result of lateral wall perforation from an aberrantly placed iliac screw during an adult spinal deformity operation involving dual screw pelvic fixation is reported. Prompt recognition, multidisciplinary collaboration, and appropriate intervention were key in achieving a successful outcome and preventing further morbidity.

Background The modified Thomas test (MTT) is commonly used to assess the flexibility of hip musculature, including the iliopsoas, rectus femoris, and tensor fascia latae. This measurement is important to include in a comprehensive musculoskeletal examination. However, existing research shows conflicting results regarding its reliability, particularly due to variations in controlling pelvic tilt during testing, which may lead to inaccurate measurements of hip extension when quantifying the test outcomes. Purpose/Hypothesis This study aimed to evaluate the intra- and inter-rater reliability of the Modified Thomas Test (MTT) in assessing hip flexor length using a goniometer. It was hypothesized that controlling for pelvic tilt would enhance the reliability of these measurements. Study Design Intra- and inter-rater reliability study Methods Sixty-four healthy individuals were recruited to participate in this study. The MTT was performed twice on each leg by both an experienced and a student physical therapist. Blinded goniometric measurements for hip extension range of motion (ROM) in the MTT position were taken with neutral pelvic tilt being enforced via palpation. A double-blind protocol was used where both examiners were unaware of each other's measurements and the goniometer was covered to blind the measuring therapist to the values as well. ROM values were entered into a Microsoft Excel spreadsheet and quantified using SPSS software. Statistical analysis included calculating Intraclass Correlation Coefficients (ICCs) and Standard Errors of Measurement (SEMs) using SPSS software. Results The study included 64 participants (mean age = 23.7 ± 4.34 years). The MTT demonstrated high intra-rater reliability (ICC = 0.911) and inter-rater reliability (ICC = 0.851). The SEMs indicated minimal variability around the mean scores. The average hip extension ROM measured was 5.43± 9.73 degrees. Conclusion These results suggest that the MTT is a reliable tool for assessing hip flexor length in clinical practice, particularly when pelvic tilt is controlled. These results have important implications for accurately testing orthopedic limitations that can contribute to low back, hip, and knee pain. Level of Evidence 3 [ABSTRACT FROM AUTHOR]

Background: Primary perivascular epithelioid cell tumors (PEComas) of the female reproductive tract have been primarily reported as case reports owing to their clinical rarity. Limited incidence rates and clinical case data hinder a comprehensive understanding of the risks and invasiveness of this disease. We discuss herein the diagnosis, treatment, and prognosis of this disease to enhance comprehension and therapeutic strategies. Methods: We conducted a clinical analysis of patients with PEComa treated at the Gynecology Department of The West China Second University Hospital of Sichuan University between May 2018 and January 2024. Diagnosis and treatment were evaluated based on pertinent literature. Results: Overall, eight patients (seven patients with tumors in the uterus and one patient with tumors in the pelvic cavity) were evaluated. One patient with PEComa of unknown malignant potential and two patients with malignant PEComa underwent hysterectomy and bilateral adnexectomy with or without adjuvant therapy and did not develop recurrence. Meanwhile, three patients who underwent lesion resection only exhibited radiological evidence of new lesions. Furthermore, postoperative imaging identified new pulmonary nodules in three patients. Conclusion: Although the current criteria are generally effective in assessing the tumor invasiveness of PEComa, emphasizing the significance of complete lesion resection remains crucial. Inadequate treatment significantly increases the risks of recurrence and metastasis. Additionally, the prevalence of pulmonary metastases may have been underestimated. Refining risk stratification to prevent overtreatment of low-grade malignancies or overlooking highly aggressive tumors is an important area for further study. [ABSTRACT FROM AUTHOR]

Tile and Young-Burgess classification systems have been widely used to classify pelvic ring injuries in clinical settings; however, these two systems are rarely mentioned in the literature despite their reproducibility and practical application. The purpose of this study was to assess the interobserver and intraobserver reliability of the Tile and Young-Burgess classification of pelvic ring injuries. Eight hundred seven patients with pelvic fractures who presented to two I-level trauma centres between January 2016 and June 2020 were recruited for this study. The anteroposterior, inlet, and outlet of the pelvis were observed on radiographic images, and CT scans were performed on each patient. The anteroposterior, inlet, and outlet of the pelvis were radiographed at each visit, and CT scans were performed. Four observers were recruited to classify the injury type according to the Young-Burgess and Tile classification systems. Interobserver and intraobserver reliability (kappa coefficient, κ) were applied to assess the reproducibility of the two classification systems. A total of 174 patients (21.56%) could not be classified with the Young-Burgess classification, and all patients could be classified according to the Tile system. The mean κ value of the interobserver reliability was 0.558 (range, 0.444 to 0.653) for the Tile classification, indicating moderate agreement, whereas the mean κ value was 0.637 (range, 0.560 to 0.713), indicating substantial agreement, when the Young-Burgess classification was used. The mean κ value for intraobserver reliability was 0.597 (range, 0.567 to 0.653) for the Tile classification and 0.776 (range, 0.748 to 0.803) for the Young-Burgess classification. More pelvic ring injuries could be classified with the Tile classification than could be classified with the Young-Burgess classification. However, the reproducibility of the Young-Burgess classification was greater than that of the Tile classification. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolism (VTE) is a severe complication following pelvic trauma. Thromboprophylaxis has reduced the risk of VTE in the pelvic trauma population; nevertheless, the risk remains high. A substantial pulmonary embolism has emerged as the unexpected cause of death among patients presenting with 'minor pelvic fractures'. The purpose of this study was to analyse the single-centre experience with a surveillance protocol. We hypothesised that DVT surveillance with VUS and CTPA may reduce the perioperative mortality–morbidity rate in the subpopulation of patients with pelvic or acetabular fractures. Methods: This is a retrospective analysis of patients admitted with pelvic or acetabular fractures between January 2001 and December 2021. In April 2013, a screening protocol for VTE was introduced. This protocol included venous ultrasound and CTPA for patients with chest injuries. Patients from two groups—one screened for VTE and one without screening—were compared. Results: Of the 3186 patients with pelvic and/or acetabular fractures who were admitted, 1975 were not screened for VTE and 1211 underwent screening. There were more VTE cases in the screening group (5.62% vs. 0.86%, p < 0.001). Nine (0.46%) cases of sudden death occurred in the non-screening group, and all of them died with symptoms of acute PE. Since the screening was introduced, we have not encountered any deaths in the perioperative period (0.46 vs. 0, p = 0.02). Conclusions: The combined use of VUS and CTPA in chest-injured patients is a trustworthy means of screening for VTE, resulting in decreased mortality rates for those with pelvic and acetabular fractures by accurately diagnosing VTE during the perioperative phase. [ABSTRACT FROM AUTHOR]

Background: Postoperative scoliosis is often seen after hemipelvectomy for malignancies involving the pelvic area, but the details remain unclear. The objectives were to investigate the development patterns and risk factors of scoliosis after hemipelvectomy. Methods: We retrospectively reviewed 30 patients who underwent hemipelvectomy at our hospital between 1998 and 2020. The risk factors of scoliosis with a Cobb angle of ≥10° were investigated. Results: The postoperative Cobb angle significantly increased in all patients compared with the preoperative one (p < 0.001), and the change ratio of the Cobb angle was significantly higher during the first postoperative year than thereafter. The external hemipelvectomy (EH) group demonstrated a larger Cobb angle and a higher change ratio than the internal hemipelvectomy group. Nine patients developed scoliosis with a final Cobb angle of ≥10°, and the risk factors were EH (p = 0.017), P1+2+3+4 resection according to the Enneking classification (p = 0.005), iliac crest resection (p = 0.004), L5/S resection (p = 0.020), and no pelvic ring reconstruction after hemipelvectomy (p = 0.004). Conclusions: Approximately 30% of patients who underwent hemipelvectomy developed scoliosis with a Cobb angle of ≥10°, and this angle increased rapidly during the first postoperative year. Hence, careful follow-up of scoliosis is required after hemipelvectomy. [ABSTRACT FROM AUTHOR]

We present two cases of patients with body mass index (BMI) >50 undergoing transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy for gynecological indications. Case 1 involves a 52‐year‐old woman with post‐menopausal bleeding and suspicion of ovarian torsion, while case 2 describes a patient with newly diagnosed endometrial adenocarcinoma. Both cases highlight the feasibility and challenges of vNOTES in this patient population. To date, this is the first paper to describe the use of vNOTES in patients of Asian ethnicity, with BMI >50. [ABSTRACT FROM AUTHOR]

Purpose To investigate the effects of deep learning reconstruction on depicting arteries and providing suitable images for the evaluation of hemorrhages with abdominopelvic contrast-enhanced computed tomography (CT) compared with hybrid iterative reconstruction. Methods This retrospective study included 16 patients (mean age: 54.2 ± 22.1 years; 8 men and 8 women) with acute hemorrhage who underwent contrast-enhanced CT. Unenhanced axial, arterial phase axial, arterial phase coronal, and delayed phase axial images were reconstructed with deep learning reconstruction, hybrid iterative reconstruction, and filtered back projection, which was used as a control in qualitative analyses. Circular and line regions of interest were placed on the aorta and superior mesenteric artery (SMA), respectively, in quantitative analyses. Using a blind process, 2 radiologists independently evaluated image noise, depiction of arteries, and suitability for the evaluation of hemorrhage in qualitative image analyses. Results Image noise in deep learning reconstruction was significantly reduced compared with hybrid iterative reconstruction in the quantitative (P < .001) and qualitative analyses (Reader 1, P ≤ .001 for all series; Reader 2, P = .002, .001, and < .001). The slope at the half maximum in deep learning reconstruction (123.8 ± 63.2 HU/mm) significantly improved compared with hybrid iterative reconstruction (105.3 ± 51.0 HU/mm) in the CT attenuation profile of the SMA (P < .001). Qualitative analyses revealed a significantly improved depiction of arteries (Reader 1, P < .001 for all series; Reader 2, P = .037, .008, and < .001) and suitability for evaluating acute hemorrhage in the arterial phase image (Reader 1, P < .001 for both series; Reader 2, P = .041 and .004) with deep learning reconstruction compared with hybrid iterative reconstruction. Discussion Deep learning reconstruction provided images with a significantly better depiction of arteries and more suitable quality arterial phase images for the evaluation of abdominopelvic hemorrhage compared with hybrid iterative reconstruction. Conclusion Deep learning reconstruction is better for reconstructing abdominopelvic contrast-enhanced CT images when evaluating hemorrhages; however, a prospective study including a large number of patients is needed to strengthen the findings of this study. [ABSTRACT FROM AUTHOR]

Background Acetabular dysplasia (AD) causes pain, limited function, and development of early hip osteoarthritis. Periacetabular osteotomy (PAO) is a surgical treatment for AD that aims to reposition the acetabulum to reduce pain and improve function. Purpose To examine pain recovery and physical activity (PA) before and during the six months after PAO. Study Design Case series, prospective Methods Individuals with AD scheduled for PAO were enrolled. Pain intensity was evaluated before PAO and at one week and one, three, and six months following PAO. PA levels was evaluated before and six months following PAO using accelerometers (time spent in sedentary behavior, light PA, moderate-to-vigorous PA [MVPA], and daily steps) and the International Physical Activity Questionnaire (IPAQ; time spent in walking and in MVPA). Pain improvements was examined over time following PAO using a repeated-measures one-way ANOVA as well as improvements in PA levels before and six months after PAO using paired-sample t tests. In addition, time spent in MVPA was qualitatively summarized at each time point (before and six months after PAO) measured by both the accelerometers and IPAQ. Results Out of 49 screened participants, 28 were enrolled, and 23 individuals (22 females; age=23.1±7.9 years) completed both study visits. Compared to pre-PAO pain, participants reported significant improvements in pain at one month and onward following PAO (p<0.011). However, PA levels at six months following PAO did not differ from pre-PAO PA levels (p>0.05). Qualitatively, participants reported spending more time in MVPA recorded by the IPAQ (pre-PAO=73.3±150.2 mins/day; six-months after PAO=121.2±192.2 mins/day), compared with MVPA recorded by accelerometers (pre-PAO=22.6±25.2 mins/ day; six-months after PAO=25.0±21.4 mins/day). Conclusions Individuals with AD reported significant pain reduction at one month and up to six months after PAO, but PA levels did not change six months after PAO compared to baseline testing. Future studies should consider examining longitudinal pain recovery and PA improvements over longer periods of time with larger samples of individuals with AD undergoing PAO and identifying modifiable factors to minimize pain and increase PA participation. Level of Evidence III [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to examine the relationship between lap belt tension and force measured at the iliac wing and the effects of model type and torso posture on this relationship. From this analysis, preliminary transfer functions were developed to predict loads applied to the iliac wing as a function of lap belt tension at magnitudes typically measured in sled and vehicle crash tests. Methods: A DOE study was conducted to provide a robust assessment of the lap belt-pelvis load relationship under various conditions. The GHBMC, THUMS, and THOR FE models were positioned in upright and reclined postures with several other intrinsic and extrinsic parameters varied for a total of 360 simulations. For the HBMs, instrumentation was developed to measure ASIS load at each iliac wing. Simulations that resulted in submarining were identified and removed from the subsequent development of lap belt-ASIS force transfer functions. Results: The GHBMC exhibited submarining more frequently than the THUMS and THOR models. In addition to submarining, there were several cases in which the lap belt remained below the ASIS instrumentation or roped during the model's forward excursion. These phenomena, particularly prevalent in the THUMS model, also influenced how the lap belt engaged the ASIS instrumentation and were thus eliminated from the transfer function development. Transfer functions relating peak lap belt tension and corresponding ASIS force magnitudes were developed for the GHBMC and THOR models in upright and reclined postures. In the upright posture, the THOR showed a higher level of ASIS load measured for a given level of lap belt tension than the GHBMC; however, in recline the lap belt-pelvis load relationship was similar between the two models. Conclusions: The lap belt-pelvis load relationship was found to be affected by model type, posture, the area in which the ASIS instrumentation was defined, and occupant kinematics. This study showed it was possible to minimize the ASIS force by having the lap belt engage low on the pelvis and upper thighs, though further study is needed to determine if this loading mechanism is truly protective from an injury standpoint or an artifact of bypassing the ASIS instrumentation. The transfer function that showed the highest ASIS force measured for a given level of lap belt tension is recommended for future use. [ABSTRACT FROM AUTHOR]

Introduction: Osteochondromas are benign tumors that arise primarily in the metaphyseal region of long bones. The malignant transformation rate is estimated to be less than 1% and 1–3% in solitary and multiple osteochondromas, respectively. Transformation to osteosarcoma is very rare. Little information is available on treatment or outcome. A rare case of osteosarcoma arising from hereditary multiple osteochondromas of the right iliac bone is reported. Case Presentation: A 66-year-old woman presented with recurrent right abdominal pain. Computed tomography (CT) showed a mass protruding into the pelvic cavity, 9 cm × 7 cm × 7 cm, with bone destruction and internal calcification in the right iliac bone. A CT-guided biopsy was performed, and the diagnosis was osteosarcoma. After one course of chemotherapy with doxorubicin and ifosfamide, extensive resection of the tumor was performed. The pathology showed proliferation of highly pleomorphic dysplastic cells with bone formation inside the tumor just below the osteochondroma tissue, which led to the diagnosis of osteosarcoma arising from the osteochondroma. Three years after surgery, there was no evidence of recurrence or metastasis, and the patient was able to walk unassisted. Conclusion: A case of osteosarcoma arising from an iliac lesion of hereditary multiple osteochondromas was described. Although no recurrence or metastasis has been observed 3 years after surgery, further follow-up is necessary due to the short time after surgery. [ABSTRACT FROM AUTHOR]

Background: This study used finite element analysis (FEA) to compare the biomechanical stability of bispherical metal augment (BA) and wedge-shaped trabecular-metal augment (TA) in different acetabular defect reconstruction models, thereby explaining the application value of this novel bispherical augment in complex hip revision. Methods: Three different acetabular defect pelvis models originating from three representative patients with different types of severe acetabular defects (Paprosky IIC, IIIA, and IIIB) were constructed and reconstruction with BA and TA technique was simulated. Based on the FEA models, the displacement of reconstruction implants, relative displacement of bone implants, and hemi-pelvic von Mises stress were investigated under static loads. Results: BA acquired smaller reconstruction system displacement, less relative displacement of bone implants, and lower pelvic von Mises stress than TA in all Paprosky IIC, IIIA, and IIIB defect reconstructions. Conclusion: The FEA results show that BA could acquire favourable biomechanical stability in severe acetabular defect reconstruction. This technique is a reliable method in complex hip revision. [ABSTRACT FROM AUTHOR]

Introduction: While pedaling, cyclists rest their pelvis on the saddle, generating pressures on it. The pressures generated on the saddle are influenced by several factors. This study aimed to evaluate whether the flexibility of hamstring and lower back muscles could be considered a predictor of pressures in the anterior region (PAR) on the saddle. Methods: For this study, 15 young off-road Italian cyclists (11m, 4f) aged 13–16 (Italian Federation categories: ES1, ES2, AL1, AL2) were recruited. Each participant was administered the V sit-and-reach (VSR) to measure the hamstring and lower back muscles flexibility. Subsequently, after performing a bike fitting, the saddle pressures during pedaling at three different intensities (100, 140, 180 W), with participants on their own bike installed on specific bike roller, were recorded. The parameters considered for statistical analysis were front pressure (%) and back pressure (%). Results: The hamstring and lower back muscles flexibility, as result of the VSR test, was a predictor of saddle PAR at 100 W (R² = 0.362, p = 0.018), at 140 W (R2 = 0.291, p = 0.038), and at 180 W (R² = 0.349, p = 0.020) of pedaling intensity. Conclusion: Higher values of the VSR could predict lower values of the pressures exerted in the front region of the saddle. The hamstring and lower back muscles flexibility may be considered a predictor of PAR on the saddle. [ABSTRACT FROM AUTHOR]

Background: Medial tibial stress syndrome (MTSS) is a prevalent running-related injury that could impact athletic performance and quality of life. The purpose of the study was to investigate the effectiveness of functional hip abductor strength training on reducing contralateral pelvic drop angle (hip frontal plane projection angle), and dynamic knee valgus (knee frontal plane projection angle) in runners with medial tibial stress syndrome (MTSS). Methods: Forty male and female recreational runners were diagnosed with MTSS for at least one month. The age ranged from 25 to 35 years old, and the body mass index (BMI) ranged between (18.5 and 25 kg/m2) participated in this study. This was a single-blind, randomized controlled trial. Participants were randomized into two groups: a control group (Group A, n = 20) received a selected physical therapy exercise program, and an experimental group (Group B, n = 20) received the same program plus functional hip abductor strength training. Dynamic knee valgus (frontal plane projection angle) and contralateral pelvic drop angle were measured using 2D video and analyzed by Kinovea software at baseline and after 8 weeks. Mixed-effect multifactor analysis of variance (MANOVA) was conducted to compare within and between groups effects on FPPA and pelvic drop angle. Results: After 8 weeks, Group B exhibited a significantly decreased frontal plane projection and pelvic drop angles compared to Group A (p < 0.05). Group A also demonstrated a reduced pelvic drop angle, but to a lesser extent, and their frontal plane projection angle increased. Conclusions: This study demonstrates that 8 weeks of functional hip abductor strength training, combined with traditional physical therapy, effectively improves lower extremity kinematics in runners with MTSS by reducing dynamic knee valgus and contralateral pelvic drop. This targeted approach likely addresses underlying muscle weakness and movement dysfunction, offering hope for potentially reducing MTSS recurrence. Trial registration: clinicaltrials.gov. NO: NCT05637476. Date: December 1, 2022. [ABSTRACT FROM AUTHOR]

Objective: To improve hip flexor flexibility, the commonly used hip extension stretch focuses on advancing the pelvis forward in a half-kneeling position, targeting only hip extension. This study aimed to compare the effectiveness of this traditional stretch with a new technique incorporating posterior pelvic tilt. Methods: A randomized crossover clinical trial was conducted with in 26 healthy, physically active individuals (52 hips), aged 22.50 ± 4.10 years. Each participant performed both the hip extension stretch and the posterior pelvic tilt stretch (26 hips), with one technique applied to each limb: the posterior pelvic tilt stretch on one limb and the hip extension stretch on the other limb (26 hips). The reactive hip flexor test and active knee extension test were measured pre and post stretching techniques. A repeated measures ANOVA was performed to assess differences between groups. Results: There was a significant group-by-time interaction with a medium effect size for the variable related to reactive hip flexor force (F = 4.775, p = 0.034, η2p = 0.087). The posterior pelvic tilt stretch had a statistically significant mean difference of 4.85 N·m (p = 0.003; 95%CI: 1.74; 7.96) compared with the hip extension stretch (mean difference = 0.06 N·m (p = 0.969; 95%CI-3.05; 3.17). No significant differences were found for active knee extension (p > 0.05). Conclusions: The results showed that the posterior pelvic tilt stretching technique was effective in reducing the hip reactive flexor force when compared to conventional hip extension stretch. [ABSTRACT FROM AUTHOR]

Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is a rare autoimmune disease, which is characterized by the immune system attacking astrocytes in the central nervous system, resulting in inflammation and damage to the nervous system. We reported a 41-year-old female patient with only drowsiness for 3 months, who was, otherwise, healthy with no other signs of meningoencephalitis or myelitis. There were no obvious abnormalities in her neurological and ophthalmic tests. Brain magnetic resonance imaging (MRI) plain scan + enhancement with the gadolinium contrast agent revealed patchy hypointensity on T1-weighted imaging, hyperintensity on T2-weighted imaging, hyperintensity on T2-weighted fluid-attenuated inversion recovery in the left basal ganglia, corona radiata, and local septum pellucida, with no enhancement in the enhanced lesions. Cerebrospinal fluid (CSF) revealed white blood cell count of 5.00 × 106/L, CSF protein of 828.53 mg/L, and glucose of 2.83 mmol/L. Aquaporin-4 (AQP4) antibody, N-methyl-D-aspartate receptor (NMDAR) antibody and GFAP antibody were all positive, whereas the remaining autoimmune encephalitis antibody tests were negative. Oncology screening [including head, chest, and whole-abdomen (involving the pelvic cavity) CT and tumor markers] did not reveal any obvious evidence of tumor presence. The patient received systemic treatment with high-dose intravenous injection of steroids combined with immunosuppressive agents, and the clinical and imaging features of the patients improved. To the best of our knowledge, reports on overlapping positivity of AQP4 antibody and NMDAR antibody in patients with GFAP astrocytopathy were still very rare. We hope to supplement the existing literature on this topic, review the relevant literature, and strive to increase the understanding toward GFAP astrocytopathy with overlapping autoimmune syndrome so as to enable early diagnosis and early treatment and to improve the clinical outcome of patients. [ABSTRACT FROM AUTHOR]

Purpose: Total Hip Arthroplasty (THA) is the primary treatment for hip diseases today. Nevertheless, total hip arthroplasty has its challenges, and one of these challenges is the potential for incorrect execution of the preoperative planning process. Such errors can lead to complications such as loosening and instability of the prosthesis and leg length discrepancy. In this study, we used human phantoms to investigate the influence of pelvic and femoral factors on prosthesis size selection in the preoperative planning of total hip arthroplasty and to provide a reference standard for clinical imaging in preoperative planning of total hip arthroplasty. Methods: In this experiment, we utilised a custom-made experimental device that enabled us to manipulate the movement of the pelvis and femur in various directions. The device also incorporated sensors to control the angle of movement. By obtaining X-rays from different positions and angles, we were able to determine the size of the prosthesis based on the 2D preoperative planning generated by the mediCAD software. Results: When the pelvis was in a nonneutral position, the size of the acetabular cup varied within a range of three sizes. Similarly, when the femur was in a nonneutral position, the size of the femoral stem varied within a range of two sizes. The movement of the pelvis and femur in the coronal plane, relative to the neutral position, did not impact the selection of the prosthesis size. However, the motion of the pelvis and femur in the sagittal and transverse planes had a notable effect. Conclusion: The selection of the prosthesis size for preoperative planning can be significantly influenced by specific positions of the pelvis and femur. It is crucial for the radiographer to ensure that the pelvis and femur maintain a standard neutral position, particularly in the sagittal and transverse planes, during the image acquisition process. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to design a low-cost, simulation training platform for the ligation of deep dorsal vein (DVC) complex in radical prostatectomy and validate its training effectiveness. Methods: A simplified prostate urethra model was produced by 0-degree silica gel and pulse pressure banding. This model was placed on a slope of about 30 degrees using cardboard to thus creating a narrow environment of the pelvis. The DVC ligation was performed by a 2D laparoscopy simulator. A total of 27 participants completed the study include 13 novices, 10 surgical residents and 4 urology experts. The novices were trained five trails with 24 hours interval, the residents and experts completed the DVC ligation once. The construct validity of this simulation training platform was performed by completing time, the GOALS (Global Operative Assessment of Laparoscopic Skills) and TSA (i.e. Task Specific Assessments) score. The face validity and content validity were performed by a specific closed-ended questionnaire. Results: There was no significant difference among three groups in demographic or psychometric variables (p > 0.05). Compared to the novices, the residents spend a shorter time to complete the DVC ligation (p < 0.05) and had higher GOALS scores (p < 0.05), but had no significant difference in TSA scores (p > 0.05). Additionally, the experts groups had a better performance compared to residents group in the completing time (p < 0.05), GOALS score (p < 0.05) and TSA score (p < 0.05). The learning curve of novices significantly promoted along with the increased times of training. Almost 90 percent of subjects considered that this simulator had a good performance in the realism and practicability. Conclusion: We developed a novel low-cost a simulation training platform for the ligation of deep dorsal vein complex in radical prostatectomy, and this simulator had a good performance in the construct validity, face validity and content validity. [ABSTRACT FROM AUTHOR]

Background: Rhabdomyosarcoma (RMS) is a rare malignant soft tissue sarcoma (STS), accounting for almost 50% of pediatric STSs. Due to its heterogeneity, RMS presents challenges in diagnosis and treatment, with prognosis varying depending on multiple factors. Tumors localized in the other site (OTH)—including the paraspinal, perianal, thoracic, abdominal, pelvic, and perineal regions—are generally classified as unfavorable. This study assesses the clinical features and prognoses of RMS in OTH locations depending on its site of origin. Methods: An explorative analysis of RMS cases from the SEER 17 database 2000–2020 was conducted. Patients of all ages with histologically confirmed RMS as primary malignant disease classified under OTH, were included. OTH was categorized in four granular site classifications. Overall survival (OS) and disease‐specific survival (DSS) were analyzed using Kaplan–Meier estimators. Factors independently influencing survival, including a site classification model presented in this study, were identified through Cox regression analysis. Results: Out of 4168 patients with RMS, 990 cases of RMS with the OTH site met the inclusion criteria. The median age was 16 years. The predominant histological subtypes were embryonal (33.0%) and alveolar (25.5%). Most tumors were ≥ 5 cm (median 9 cm) and located primarily in the pelvic region (41.5%). The 3‐, 5‐, and 10‐year OS rates were 45.4% ± 3.332 (95% CI), 40.7 ± 3.332, and 38.6% ± 3.332, respectively, while DSS rates were 43.3% ± 3.136 (95% CI), 38.3% ± 3.136, and 35.1% ± 3.332. In the multivariate analysis age, histological type, site in a granular categorization, stage, regional lymph node examination, and regional lymph node involvement (pathologically proven) were independently associated with survival. Through both univariate and multivariate analyses, an OTH favorable group could be established. The OTH favorable group consists of the anal region, gallbladder and biliary tract, and breast. Conclusion: RMS in OTH shows significant differences in prognosis, putting the current categorization as unfavorable into question and making a more detailed classification necessary. Furthermore, pathological regional lymph node assessment is specifically in the OTH localization recommended. [ABSTRACT FROM AUTHOR]

Background: Operative treatment of fragility fractures of the pelvis has become a gold standard. Preoperative planning, including the assessment of the pathway for iliosacral screws, is crucial. The anchorage of the screw depends on the bone quality. Some recent studies have concentrated on assessing bone mineral density (BMD) with the use of Hounsfield unit (HU) values obtained from CT scans. The aim of the present study is to determine the best sacral levels of S1–S3 on the pathway of iliosacral screws for sacroiliac joint fixation. Methods: Patients admitted to the Independent Public Healthcare Center in Rypin between 1 of September and 1 of December in 2023, who had CT scans of the pelvis performed on them for different reasons, were included in this study. In total, 103 patients—56 men and 47 women—were enrolled in the study and consecutively separated into two groups of different ages: 18–60 years old (group A) and above 60 years old (group B). The volumetric bone density expressed in HU values was measured with sacral levels of S1, S2 and S3. Apart from the bodies of sacral vertebrae S1–S3, our measurements involved the ala of the ilium in the vicinity of the sacroiliac joint and the wing of the sacrum. All the measurements were performed on the pathway of presumptive iliosacral screws to stabilize the sacroiliac joint. Results: In group A (58 patients) the highest bone density in sacral bodies was found in S1 that gradually decreased to S3, while the opposite tendency was demonstrated in the ala of ilium. The HU values in the wing of the sacrum did not display statistical significance. In group B (45 patients), the highest bone density was also found in the sacral body S1 that decreased toward S3 but in the ala of ilium, the highest bone density was found with level S1 and lowest with level S2. In both groups, the highest bone density referred to the wing of the sacrum. Conclusion: While the perfect construct for posterior pelvic ring fixation remains unclear, our findings may imply that sacroiliac joint screws inserted into the wing of the sacrum of greater bone density could provide much more successful fixation in comparison to those anchored in the body of sacral vertebra of lesser bone density. [ABSTRACT FROM AUTHOR]

The intestinal tract is a typical radiosensitive tissue, and radiation rectal injury is a severe side effect that limits the prescribed dose in radiotherapy of the abdominal and pelvic region. Understanding the post-irradiation kinetics of Lgr5-positive stem cells is crucial in comprehending this adverse process. In this study, we utilized Lgr5-EGFP knock-in mice expressing EGFP and LGR5 antibody fluorescence staining of wild-type mice. At the state of radiation injury, the qPCR analysis showed a significant decrease in the expression level of Lgr5 in the rectal epithelial tissue. The dose-response relationship analysis showed that at low to moderate doses up to 10 gray (Gy), Lgr5-clustered populations were observed at the base of the crypt, whereas at sublethal doses (20 Gy and 29 Gy), the cells exhibited a dot-like scatter pattern, termed Lgr5-dotted populations. During recovery, 30 days post-irradiation, Lgr5-clustered populations gradually re-emerged while Lgr5-dotted populations declined, implying that some of the Lgr5-dotted stem cell populations re-clustered, aiding regenerations. Based on statistical analysis of the dose-response relationship using wild-type mice, the threshold dose for destroying these stem cell structures is 18 Gy. These findings may help set doses in mouse abdominal irradiation experiments for radiation intestinal injury and for understanding the histological process of injury development. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions CT examinations commonly start with the acquisition of one or two localizer radiographs (2D localizers). Recently, a manufacturer introduced the option to perform a heavily filtrated low‐dose helical scan as a localizer acquisition. To compare the dose of one or two 2D localizer acquisitions to the dose of a 3D localizer acquisition, one cannot simply compare the CTDIs of the different acquisition techniques, because of the use of different geometries and spectra.To compare the organ and effective dose for various CT localizer acquisition techniques.A Geant4‐based Monte Carlo simulation, replicating a clinical wide‐area CT scanner was developed and validated. Various localizer acquisition strategies were simulated: Anterior‐posterior (AP) alone, PA alone, combined AP+lateral (LAT), and PA+LAT 2D localizers, and an Ag‐filtered 3D localizer acquisition. Validation was performed by measuring and simulating CTDI100 in both the periphery and the center of a CTDI phantom. The software was subsequently used to estimate organ and effective doses for localizers for chest, abdomen + pelvis, and the combined chest, abdomen, and pelvis exams. As representations of patients, eight ICRP computational phantoms (adult, 15‐, 10‐, and 5‐year, both male and female) and five female and five male XCAT phantoms with various BMIs were used. The dose of the various strategies was compared to the current clinically‐implemented AP+LAT localizers.CTDI100‐measurements and simulations within the CTDI‐phantom differs by a maximum of 8.1% and by an average of 0.9%. For chest, the average effective doses for AP, PA, AP+LAT, and the 3D localizer are 0.10, 0.07, 0.32, and 0.22 mSv, respectively. The organ dose to the breast varies the most across the various localizer strategies and is, on average, 0.17, 0.03, 0.44, and 0.33 mGy, in the same order. For abdomen, the average effective doses are 0.11, 0.07, 0.36, and 0.25 mSv for the AP, PA, AP+LAT and the 3D localizer, respectively. The organ dose to the stomach varies the most across the various localizers and is on average 0.14, 0.08, 0.58, and 0.30 mGy, in the same order. The PA‐only localizer results in the lowest organ dose to the most radiosensitive organs and the lowest effective dose. For the chest exam, compared to AP+LAT, the PA+LAT results in a 7 ± 2% effective dose reduction (mean ± standard deviation), while the 3D localizer results in a 21 ± 3% effective dose reduction. Using AP or PA only would result in 69 ± 2% and 76 ± 2% reduction, respectively. For the abdomen exam, also compared to AP+LAT, PA+LAT results in 6 ± 2% effective dose reduction, while the 3D localizer results in a 20 ± 5% reduction. Using AP or PA only would result in 69 ± 5% and 76 ± 4% reduction, respectively.Using a PA localizer results in a lower or equivalent organ dose in the most radiosensitive organs, and a lower effective dose compared to an AP localizer for both chest and abdomen+pelvis exams. Compared to a two‐localizer strategy, the 3D localizer results in a lower effective dose in both the chest and abdomen+pelvis region. [ABSTRACT FROM AUTHOR]

Keel bone damage, include deviations and fractures, is common in both white and brown laying hens, regardless of the housing system. Radiography for assessing birds' keel bones is was proposed by previous studies. However, radiographs show only 2 out of 3 dimensions of the dissected keel bones. The current study aimed to (1) investigate the association of radiographic optical density (keel and tibiotarsal) and geometry (keel) with dissected keel bone pathology. Previous studies suggested that keel bone fractures may result from internal pressure exerted by pelvic cavity contents. The current study also aimed to (2) investigate the potential associations between pelvic dimensions and measures of keel bone damage. A sample of 200 laying hens on a commercial farm were radiographed at 16, 29, 42, 55, and 68 weeks, and culled at the end of the laying period (week 74). The birds were examined post-mortem for pelvic dimensions and underwent whole-body radiography, followed by keel and tibiotarsal bone dissection and radiography, and keel bone scoring. The radiographs were used to estimate radiographic optical density (keel and tibiotarsal bone) and keel bone geometry (ratio of keel bone length to mid-depth). The method for on-farm radiography of laying hens, including live bird restraint, positioning for live keel imaging, and post-imaging measurements, was developed, tested, and found to be reproducible. The radiographs (1,116 images of 168 birds) and the respective measurements and post-mortem scores of keel bones are also provided for further development of radiographic metrics relevant to keel bone damage. Some longitudinal radiographic measurements of keel geometry (ratio of length to mid-depth) and optical density (keel and tibiotarsal) showed associations with the damage (deviations/fractures) observed on the dissected keel bones. The associations of keel damage were clearer with the radiographic keel geometry than with keel and tibiotarsal optical density, also clearer for the keel deviations than for keel fractures. The higher radiography ratio of keel length to middepth at weeks 42, 55 and 68 of age, the larger deviations size observed on the dissected keels at age of 74 weeks. The higher the tibiotarsal radiographic optical density at week 55 of age, the lower deviations size and fractures count observed on the dissected keels at age of 74 weeks. Pelvic dimensions showed a positive correlation with body weight, but a larger pelvic cavity was associated with increased keel bone damage. These findings lay the foundations for future use of on-farm radiography in identifying appropriate phenotypes for genetic selection for keel bone health. [ABSTRACT FROM AUTHOR]

Background/Aim. Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a condition with recurring discomfort or pain in the urinary bladder and the surrounding pelvic region without an identifiable disease. The aim of this study was to assess hydrodistension as a diagnostic and treatment procedure in patients with BPS. Methods. This prospective study included 45 patients who underwent cystoscopy with hydrodistension. The m ean v alues f or 2 4-hr voiding frequency, maximal voided urine volume, average voided urine volume, and minimal voided urine volume originated from the frequency volume chart. The values were compared between the time before hydrodistension and one, three, and six months after that. Results. By comparing the initial data and data in all three follow-up periods (after one, three, and six months), the statistical significance (p < 0.046) was found, and that: for 24-hr voiding frequency, it was 19.64 ± 3.56, 9.42 ± 1.71, 9.58 ± 1.45, and 12.2 ± 2.79, respectively; then, for the minimal voided urine volume (p < 0.03), it was 59.11 ± 23.72 mL, 114.89 ± 4.09 mL, 112.44 ± 100.86 mL, and 89.00 ± 29.45 mL, respectively; for an average voided volume (p < 0.04), it was 105.33 ± 18.29 mL, 186.89 ± 23.14 mL, 186.44 ± 21.44 mL, and 155.78 ± 30.78 mL, respectively. There was no significant statistical difference (p < 0.1) regarding the maximal voided urine volume between initial and follow-up interval data: 196.89 ± 43.68 mL, 312.89 ± 54.59 mL, 316.00 ± 49.47 mL, 266.67 ± 53.17 mL, respectively. Conclusion. Our results demonstrate that hydrodistension is a reliable diagnostic and therapeutic procedure. [ABSTRACT FROM AUTHOR]

A case report published in the International Journal of Rheumatic Diseases discusses a rare occurrence of SAPHO syndrome and pelvic lipomatosis in a 60-year-old male patient. The patient experienced significant improvement in both conditions after treatment with adalimumab. The study highlights the successful use of adalimumab in treating these co-occurring conditions, providing valuable insights for better understanding and managing SAPHO syndrome with or without pelvic lipomatosis. [Extracted from the article]

Key content: Urethral caruncle is a common post‐menopausal finding.This common benign lesion can be mistaken as a malignancy.Management should be based on the patient's symptoms.Vaginal estrogen should be considered as first‐line management before surgical excision. Learning objectives: To evaluate the symptomatic presentation of urethral caruncle.To establish the differential diagnosis of a mass in the urethra.To review the management options of urethral caruncle including medical and surgical excision.To highlight primary care management of urethral caruncle. Ethical issues: Owing to poor recognition of urethral caruncle, many patients are put through the emotional distress of referral to cancer pathways.Surgery should be considered first line for large urethral caruncle or in symptomatic patients. [ABSTRACT FROM AUTHOR]

Purpose: Underweight patients experience poor outcomes after elective orthopaedic procedures. The effect of underweight body mass index (BMI) on complications after acetabular fracture is not well-described. We evaluate if underweight status is associated with inpatient complications after acetabular fractures. Methods: Adult patients (≥ 18 years) presenting with acetabular fracture between 2015 and 2019 were identified from Trauma Quality Program data. Adjusted odds (aOR) of any inpatient complication or mortality were compared between patients with underweight BMI (< 18.5 kg/m2) and normal BMI (18.5–25 kg/m2) using multivariable logistic regression and stratifying by age ≥ 65 years. Results: The 1299 underweight patients aged ≥ 65 years compared to 11,629 normal weight patients experienced a 1.2-times and 2.7-times greater aOR of any complication (38.6% vs. 36.6%, p = 0.010) and inpatient mortality (7.9% vs. 4.2%, p < 0.001), respectively. The 1688 underweight patients aged 18–64 years compared to 24,762 normal weight patients experienced a 1.2-times and 1.5-times greater aOR of any inpatient complication (38.9% vs. 34.8%, aOR p = 0.006) and inpatient mortality (4.1% vs. 2.5%, p < 0.001), respectively. Conclusion: Underweight adult patients with acetabular fracture are at increased risk for inpatient complications and mortality, particularly those ≥ 65 years old. Level of Evidence: Prognostic Level III. [ABSTRACT FROM AUTHOR]

Incomplete sacroiliac joint injuries are often associated with external rotation and extension deformities on the injured hemipelvis. To appropriately correct this deformity, an oblique reduction force from caudal to cranial and lateral to medial is helpful. These injuries are often associated with traumatic disruption of the pubic symphysis. However, in injuries without traumatic disruption to the pubic symphysis, a two-pin oblique anterior external fixator can be used to obtain and maintain reduction of the sacroiliac joint, while percutaneous fixation is subsequently placed. Through a small case series and three specific patient examples, we demonstrate that the oblique anterior external fixator frame is a simple and effective strategy with the reduction and stabilization process of these multiplanar hemipelvis deformities. [ABSTRACT FROM AUTHOR]

Purpose: While decreased time to fixation in femur fractures improves mortality, it remains unclear if the same relationship exists for pelvic fractures. The National Trauma Data Bank (NTDB) is a data repository for trauma hospitals in the United States (injury characteristics, perioperative data, procedures, 30-day complications), and we used this to investigate early, significant complications after pelvic-ring injuries. Methods: The NTDB (2015–2016) was queried to capture operative pelvic ring injuries in adult patients with injury severity score (ISS) ≥ 15. Complications included medical and surgical complications, as well as 30-day mortality. Multivariable logistic regression was used to investigate the association between days to procedure and complications after adjusting for demographic characteristics and comorbidities. Results: 2325 patients met inclusion criteria. 532 (23.0%) sustained complications, and 72 (3.2%) died within the first 30 days. The most common complications were deep vein thrombosis (DVT) (5.7%), acute kidney injury (AKI) (4.6%), and unplanned intensive care unit (ICU) admission (4.4%). In a multivariate analysis, days to procedure was independently significantly associated with complications, with an adjusted odds ratio (95% confidence interval) of 1.06 (1.03–1.09, P < 0.001), best interpreted as a 6% increase in the odds of complication or death for each additional day. Conclusion: Time to pelvic fixation is a significant and modifiable risk factor for major complications and death. This suggests we should prioritize time to pelvic fixation on trauma patients to minimize mortality and major complications. [ABSTRACT FROM AUTHOR]

Background: While there are established international consensuses on the delineation of pelvic lymph node regions (LNRs), significant inter‐ and intra‐observer variabilities persist. Contouring these clinical target volumes for irradiation in pelvic malignancies is both time‐consuming and labor‐intensive. Purpose: The purpose of this study was to develop a deep learning model of pelvic LNRs delineation for patients with pelvic cancers. Methods: Planning computed tomography (CT) studies of 160 patients with pelvic primary malignancies (including rectal, prostate, and cervical cancer) were retrospectively collected and divided into training set (n = 120) and testing set (n = 40). Six pelvic LNRs, including abdominal presacral, pelvic presacral, internal iliac nodes, external iliac nodes, obturator nodes, and inguinal nodes were delineated by two radiation oncologists as ground truth (Gt) contours. The cascaded multi‐heads U‐net (CMU‐net) was constructed based on the Gt contours from training cohort, which was subsequently verified in the testing cohort. The automatic delineation of six LNRs (Auto) was evaluated using dice similarity coefficient (DSC), average surface distance (ASD), 95th percentile Hausdorff distance (HD95), and a 7‐point scale score. Results: In the testing set, the DSC of six pelvic LNRs by CMU‐net model varied from 0.851 to 0.942, ASD from 0.381 to 1.037 mm, and HD95 from 2.025 to 3.697 mm. No significant differences were founded in these three parameters between postoperative and preoperative cases. 95.9% and 96.2% of auto delineations by CMU‐net model got a score of 1–3 by two expert radiation oncologists, respectively, meaning only minor edits needed. Conclusions: The CMU‐net was successfully developed for automated delineation of pelvic LNRs for pelvic malignancies radiotherapy with improved contouring efficiency and highly consistent, which might justify its implementation in radiotherapy work flow. [ABSTRACT FROM AUTHOR]

Background: Cone beam CT (CBCT) is widely utilized in clinics. However, the scatter artifact degrades the CBCT image quality, hampering the expansion of CBCT applications. Recently, beam‐blocker methods have been used for CBCT scatter correction and proved their high cost‐effectiveness. Purpose: A rotating beam‐blocker (RBB) method for CBCT scatter correction was proposed to complete scatter correction and image reconstruction within a single scan in both full‐ and half‐fan scan scenarios. Methods: The RBB consisted of two open regions and two blocked regions, and was designed as a centrosymmetric structure. The open and blocked projections could be alternatively obtained within one single rotation. The open projections were corrected with the scatter signal calculated from the blocked projections, and then used to reconstruct the 3D image via the Feldkamp‐Davis‐Kress algorithm. The performance of the RBB method was evaluated on head and pelvis phantoms in scenarios with and without a bowtie filter. The images obtained from nine repeated scans in each scenario were used to calculate the evaluation metrics including the CT number error, spatial nonuniformity (SNU) and contrast‐to‐noise ratio (CNR). Results: For the head phantom, the CT number error was decreased to <5 after scatter correction from >200 HU before correction when scanned without a bowtie filter, and to <4 from >160 HU when scanned with a full bowtie filter. For the pelvis phantom, the CT number error was reduced to <12 after scatter correction from >250 HU before correction when scanned without a bowtie filter, and to <10 from >190 HU when scanned with a half bowtie filter. After scatter correction, the uniformity and contrast were both improved, resulting in an SNU of >79% decrease and CNR of >2 times increase, respectively. Conclusions: High‐quality CBCT images could be obtained in a single scan after using the proposed RBB method for scatter correction, enabling more accurate image guidance for surgery and radiation therapy applications. With almost no time delay between the successive open and blocked projections, the RBB method could eliminate the motion‐induced anatomical mismatches between the corresponding open and blocked projections and could find particular usefulness in thoracic and abdominal imaging. [ABSTRACT FROM AUTHOR]

Background/Objectives: The impact of surgical resection versus non-resection on cancer-specific mortality (CSM) in soft tissue pelvic sarcoma remains largely unclear, particularly when considering histologic subtypes such as liposarcoma, leiomyosarcoma, and sarcoma NOS. The objective of the present study was to first report data regarding the association between surgical resection status and CSM in soft tissue pelvic sarcoma. Methods: Using data from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2019, we identified 2491 patients diagnosed with pelvic soft tissue sarcoma. Cumulative incidence plots were used to illustrate CSM and other-cause mortality rates based on the histologic subtype and surgical resection status. Competing risk regression models were employed to assess whether surgical resection was an independent predictor of CSM in both non-metastatic and metastatic patients. Results: Among the 2491 patients with soft tissue pelvic sarcoma, liposarcoma was the most common subtype (41%), followed by leiomyosarcoma (39%) and sarcoma NOS (20%). Surgical resection rates were 92% for liposarcoma, 91% for leiomyosarcoma, and 58% for sarcoma NOS in non-metastatic patients, while for metastatic patients, the rates were 55%, 49%, and 23%, respectively. In non-metastatic patients who underwent surgical resection, five-year CSM rates by histologic subtype were 10% for liposarcoma, 32% for leiomyosarcoma, and 27% for sarcoma NOS. The multivariable competing risk regression analysis showed that surgical resection provided a protective effect across all histologic subtypes in non-metastatic patients (liposarcoma HR: 0.2, leiomyosarcoma HR: 0.5, sarcoma NOS HR: 0.4). In metastatic patients, surgical resection had a protective effect for those with leiomyosarcoma (HR: 0.6) but not for those with sarcoma NOS. An analysis for metastatic liposarcoma was not possible due to insufficient data. Conclusions: In non-metastatic soft tissue pelvic sarcoma, surgical resection may be linked to a reduction in CSM. However, in metastatic patients, this protective effect appears to be limited primarily to those with leiomyosarcoma. [ABSTRACT FROM AUTHOR]

Anastomotic leakage and subsequent pelvic sepsis are serious complications after surgery for pelvic malignancies, particularly challenging due to the large pelvic cavity dead space post‐exenteration. We report a 47‐year‐old man treated for a severely infected pelvic hematoma and sepsis following anastomotic leakage after anterior pelvic exenteration. Post robot‐assisted exenteration for locally advanced sigmoid colon cancer treated with neoadjuvant chemotherapy, a pelvic abscess from anastomotic dehiscence was identified. Initial CT‐guided drainage and subsequent laparoscopic drainage were performed. On postoperative day 22, a bleeding left internal iliac pseudoaneurysm required embolization. Despite these efforts, the sepsis worsened due to an enlarged, infected hematoma. Endoscopic lavage, in collaboration with skilled endoscopists, successfully removed the hematoma, leading to an improved inflammatory response, and the patient was discharged. Endoscopic lavage proved to be the safest and most effective treatment for pelvic sepsis with an infected hematoma after various attempted interventions. [ABSTRACT FROM AUTHOR]

Purpose: Fractures and dislocations of the pelvic ring are complex injuries that when treating require meticulous attention to detail and often specialized technical skill. These injuries can be the result of high-energy trauma, particularly in younger patients, or low energy trauma more often found in the elderly. Regardless of mechanism, these injuries lie on a spectrum of severity and can be treated conservatively or surgically. Percutaneous fixation under fluoroscopic guidance is the preferred standard technique when treating these fractures. This technique can be challenging for a variety of reasons including patient characteristics, intra-operative image quality, fracture morphology, among others. Methods: This retrospective study evaluated the use of intra-operative computed tomography (CT) using an O-arm imaging system for critical evaluation of fluoroscopic-guided screw placement in twenty-three patients. We retrospectively reviewed all cases of patients who were treated by three fellowship-trained orthopaedic traumatologists during a one-year span. Patients undergoing percutaneous pelvis fixation using both standard fluoroscopy and intraoperative CT with the Medtronic O-arm® (Minneapolis, MN) imaging system. Additionally, procedures performed included open reduction internal fixation (ORIF) of the pelvic ring, acetabulum, and associated extremity fractures. Results: Twenty-three patients were included in this study. On average, the use of intraoperative CT added 24.4 min in operative time. Five patients (21.7%) required implant adjustment after O-arm spin. Fourteen patients underwent additional post-operative CT. No secondary revision surgeries were attempted after any post-operative CT. Conclusions: Our study suggests that intra-operative CT scan, compared to post-operative CT scan, can be utilized to prevent take-back surgery for misplaced implants and allow for adjustment in real-time. [ABSTRACT FROM AUTHOR]

Equations for predicting body mass from stature and bi‐iliac (maximum pelvic) breadth have been developed, but have had variable success when applied to living or recently deceased individuals, calling into question their general applicability. Here we test these equations on a large, ethnically diverse sample. Skeletal and anthropometric data for 507 recently deceased Indigenous, Hispanic, and non‐Hispanic White adults were obtained from the New Mexico Decedent Image Database. The body mass of individuals with a "normal" body mass index (BMI = 18.5–24.9) is very accurately predicted, with an average directional bias of about 1% and an average random error of less than 8%. Underweight individuals (BMI < 18.5) are overpredicted, while overweight (BMI = 25–29.9) and especially obese (BMI≥30) individuals are underpredicted. Within BMI categories, there is a strong and isometric relationship between predicted and true body mass. Individual body mass prediction errors using the stature/bi‐iliac method are mainly dependent on variation in BMI. Because earlier humans were more likely to fall within or close to the normal BMI range, the equations should be applicable, on an individual basis, in archeological and paleontological contexts. Because of the prevalence of obesity in many modern populations, these equations are not applicable in a general forensic context. We derive new equations from nonobese individuals in our sample (n = 338), which produce reasonable average prediction errors. If obese individuals can be identified using other skeletal parameters, these equations may be useful in estimating body mass in nonobese forensic cases. [ABSTRACT FROM AUTHOR]

Objective: To identify the effects of patient risk factors and pelvic venous reflux (PVR) patterns on treatment outcomes of Pelvic Vein Embolisation (PVE) for Pelvic Venous Disorder (PeVD). Methods: We performed a retrospective cohort review assessing population, intervention, comparison, and outcomes (PICO) for women undergoing PVE for PVR January 2017–January 2021. We identified 190 patients who had completed both questionnaires and who had given consent for their information to be used for research (Median age 46, IQR 40-52). The distribution of pathological pelvic venous reflux found on transvaginal duplex ultrasound (TVDUS) was analysed for all patients. Pre- and post-procedure symptom burden scores were studied using a standardised questionnaire protocol. We used inferential univariate non-parametric statistics to describe our data. Results: 190 cases were reviewed; 62.6% (119/190) premenopausal, 11.1% (21/190) perimenopausal, 25.3% (48/190) postmenopausal and menopausal status not documented 1% (2/190). 10.1% (19/188) were nulliparous (average age 34 years; range 20-55 years). There was a statistically significant improvement in all symptoms and in the appearance of varicosities on TVDUS post-PVE (P < 0.05) of the ovarian vein plexus, uterus plexus, arcuate veins, vaginal wall, peri-urethral, peri-anal, haemorrhoids, labial and proximal thigh. The locations of veins requiring embolisation having demonstrated reflux were analysed; 82.8% (154/186) underwent embolisation of at least one internal iliac vein tributary and ovarian vein embolisation. Age, parity, menopausal status and previous laparoscopy did not affect symptom improvement (P > 0.05). No significant complications such as coil migration were observed. Conclusions: PVE is an effective treatment for pelvic pain due to PeVD and its diagnosis should not be limited to multiparous women of childbearing age, as a significant proportion of patients who benefited from PVE were either nulliparous and/or postmenopausal. [ABSTRACT FROM AUTHOR]

• Lumbopelvic distance reduction enhances stability after total sacrectomy. • Lumbopelvic distance reduction lowers the bone-implant and rod stress. • All reconstruction techniques are suitable for lumbopelvic stabilization. • Regardless of the used technique, LPDR is biomechanically advantageous. Following total sacrectomy, lumbopelvic reconstruction is essential to restore continuity between the lumbar spine and pelvis. However, to achieve long-term clinical stability, bony fusion between the lumbar spine and the pelvic ring is crucial. Reduction of the lumbopelvic distance can promote successful bony fusion. Although many lumbopelvic reconstruction techniques (LPRTs) have been previously analyzed, the biomechanical effect of lumbopelvic distance reduction (LPDR) has not been investigated yet. To evaluate and compare the biomechanical characteristics of four different LPRTs while considering the effect of LPDR. A comparative finite element (FE) study. The FE models following total sacrectomy were developed to analyze four different LPRTs, with and without LPDR. The closed-loop reconstruction (CLR), the sacral-rod reconstruction (SRR), the four-rod reconstruction (FRR), and the improved compound reconstruction (ICR) techniques were analyzed in flexion, extension, lateral bending, and axial rotation. Lumbopelvic stability was assessed through the shift-down displacement and the relative sagittal rotation of L5, while implant safety was evaluated based on the stress state at the bone-implant interface and within the rods. Regardless of LPDR, both the shift-down displacement and relative sagittal rotation of L5 consistently ranked the LPRTs as ICR

The objective of this study was to establish an evaluation technique for the feline pelvic cavity using computed tomography (CT). Client-owned cats with a normal pelvis (n = 50) or pelvic stenosis (n = 3) were included. We categorized pelvic CT images in the normal pelvis group into two types according to pelvic cavity shape, then calculated the sacral index (SI), pelvic canal area (PCA), and PCA/sacral width index (PSI). The reference intervals of these variables were determined based on the results in the normal pelvis group. In the normal pelvis group, the PSI, unlike the SI and PCA, was not affected by body weight. In addition to high intraobserver and interobserver reproducibilities, the PSI showed no significant differences according to pelvic cavity shape. However, the SI exhibited significant differences among pelvic cavity shapes. In the stenosis group, the postoperative PSI in all cats was within the reference interval. However, the postoperative SI in one case was lower than the reference interval. The PSI may become a new method for evaluation of the pelvic cavity, including the pelvic floor. [ABSTRACT FROM AUTHOR]

Background: The number of hip arthroscopies performed in the United States has grown significantly over the past several decades, with evolving indications and emerging techniques. Purposes: To (1) examine the evolution of hip arthroscopy at 3 tertiary referral centers between 1988 and 2022 and (2) quantify trends in patient demographics and procedures performed. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was performed of all patients undergoing hip arthroscopy at 3 academic centers between 1988 and 2022. Demographic data were collected using standardized forms and operative notes, and intraoperative images were manually reviewed for each patient to determine the specific procedures performed at the time of the hip arthroscopy. Surgical procedures were plotted over time to evaluate trends. Patients were divided into 3 time periods for comparison: early hip arthroscopy from 1988 to 2008, 2009 (the time of the first labral repair in our cohort) to 2015, and 2016 to 2022. Results: A total of 3000 patients (age, 35.7 ± 13.8 years; age range, 10-89 years; female sex, 2109 (70.3%); body mass index, 27.4 ± 6.3 kg/m2) underwent arthroscopic hip procedures between 1988 and 2022. The mean number of cases increased from a mean of 3.2 per year in 1988-2008 to 285.9 per year in 2016-2022 (P <.001). Labral treatment at the time of primary hip arthroscopy evolved from 100% debridement and 0% repair in 1988-2008 to 5.0% debridement, 94.0% repair, and 1.0% labral reconstruction in 2016-2022 (P <.001). Cam resection increased from 4.1% in 1988-2008 to 86.9% in 2016-2022 (P <.001). By 2022, 45 out of 325 cases (13.8%) were revisions. The rate of capsular repair at the time of primary hip arthroscopy increased from 0.0% in 1988-2008 up to 81.0% in 2016-2022. Conclusion: There has been a significant growth of hip arthroscopy volumes as well as a significant transition from use as a tool for diagnosis and labral debridement to procedures restoring native anatomy including labral repair, cam resection, capsular repair, periacetabular osteotomy, and gluteal repair. [ABSTRACT FROM AUTHOR]

Patients with tumor thrombosis in the portal vein due to hepatocellular carcinoma (HCC) are uncommon, and the majority of these cases is thought to be in an advanced stage with a bad prognosis. The right atrium and the inferior vena cava may be impacted by the intravascular tumor thrombus, with the latter having a bad prognosis. Portal vein involvement is one of the most serious consequences of HCC. For both systemic and locoregional therapy, targeting many pathways in the HCC cascade using a mix of medications and additional modalities like transarterial chemoembolization, transarterial radioembolization, radiation, and hepatic arterial infusion chemotherapy appears to be helpful. Portal vein tumor thrombosis, which affects 35 to 50% of patients, is a strong predictor of poor prognosis due to the higher likelihood of tumor migration into the bloodstream and the subsequent increased risk of recurrence. This case report highlights about a 60-year-old female who presented with HCC with portal vein tumor thrombosis not willing for chemo- and radiotherapy successfully treated with transarterial chemoembolization as a palliative management. [ABSTRACT FROM AUTHOR]

Background: Chuna manual therapy (CMT), a Korean manual therapy technique predominantly used for treating low back pain (LBP) and related disorders, lacks well-conceived research focusing on its comparative effectiveness, safety, and economic evaluation, particularly with respect to complex CMT with established CMT diagnostic algorithms. This study aims to illustrate a protocol for a randomized clinical study for comparative effectiveness and cost-effectiveness of complex CMT with simple CMT and usual care. Methods: This is a protocol for a three-armed, multicenter, assessor-blinded, pragmatic, randomized controlled trial study. A total of 81 patients suffering from non-acute LBP with pelvic biomechanical lesions (PBL), characterized by a pain duration of at least two weeks and a Numeric Rating Scale (NRS) score of 5 or higher, will be recruited from two Korean medicine hospitals. These participants will be randomly assigned to one of three groups: complex CMT plus usual care (UC; n = 27), simple CMT plus UC (n = 27), or UC groups (n = 27). They will undergo treatment for 4 weeks, and follow-up assessments will be performed 8 weeks after treatment completion. The primary outcome will be the NRS score of LBP, and secondary outcomes will include the Oswestry Disability Index, Patient Global Impression of Change, credibility and expectancy questionnaire, three-dimensional posture analysis indicators, quality of life assessment, economic evaluation, and safety assessments. Discussion: This will be the first study to assess the comparative effectiveness, safety, and cost-effectiveness of complex CMT compared to UC and simple/complex CMT in patients with LBP and PBL. We will also analyze useful diagnostic methods to help in clinical practice for CMT diagnosis. Trial registration: Clinical Research Information Service (CRIS), KCT0009210. Registered on February 28, 2024. [ABSTRACT FROM AUTHOR]

Background: The diaphragm muscle constitutes the internal component of the Lumbo-Pelvic-Hip Complex (LPHC), and its stability is suggested to influence lower limb joint function, particularly the alignment of the patellofemoral joint and the tracking path mechanism of the patella. Objectives: To compare the endurance of the LPHC and diaphragm contractility in females with patellofemoral pain syndrome (PFPS) and a healthy control group. Methods: Fifty-six females, including twenty-eight diagnosed with patellofemoral pain syndrome and twenty-eight healthy females matched as controls (aged 15 - 45), were invited to participate in this case-control study. Endurance scores of trunk extensor, flexor, and lateral flexor muscles, endurance ratios, and the percentage of diaphragm muscle contractility using the ultrasonography method were compared between the two groups. Results: The endurance time of trunk flexors and right and left lateral muscle groups in the PFPS group significantly differed compared to the control group (P < 0.05). Diaphragm contractility in both the right (Mean ± SD: 21.82 ± 3.61; P < 0.001) and left (Mean ± SD: 22.92 ± 2.99; P = 0.007) sides was significantly lower in the PFPS group compared to the control group. Conclusions: Lumbo-Pelvic-Hip Complex stability and diaphragm respiratory function and contractility were impaired in females with PFPS. [ABSTRACT FROM AUTHOR]

Our goal is to further understand how a simulated extravehicular mobility unit (xEMU) spacesuit affects the relative movement of one's body segments. The effect of the xEMU spacesuit on gait is not yet fully understood. Here, gait was examined in terms of postural strategies, defined by the absolute angle with standard deviation (AAD) and the anchoring index (AI). The AAD values allowed the measurement of the absolute angles of body segments and their standard deviation, whereas the AI provided a measure of how stable a body segment was relative to a global reference frame and the inferior body segment. The body segments examined were the head, thorax, lumbar, and pelvis segments of 17 participants (26.53 ± 6.51 years old). The configurations tested included unsuited, or using a xEMU Vest or a hard upper body torso (HUT) for four walking conditions: eyes open/closed, with either forward or backward walking. The AAD values of the xEMU Vest were insignificant compared to those of the unsuited condition. The HUT significantly affected the AAD values compared to the unsuited condition. The AI for the HUT also indicates a new unique postural strategy being employed by the HUT group that was not previously observed. [ABSTRACT FROM AUTHOR]

Purpose: To minimize radiation exposure to the small bowel (SB) in patients undergoing treatment for gynecological tumors by adopting a comfortable positioning method. Methods and patients: All 76 women undergoing Intensity-Modulated Radiation Therapy (IMRT) were included in this study. Patients were immobilized in a supine position using a vacuum bag and thermoplastic cast formation. In the trial group (n = 36), patients raised their buttocks and a solid foam pad was placed under the sacral tail before immobilization. The control group (n = 40) received treatment in the standard supine position. The SB was delineated from the pubic symphysis to the total iliac bifurcation in computed tomography (CT) scans. Result: In the trial group, a significant reduction in SB volume within the pelvic cavity was observed (mean 399.17 ± 158.7 cc) compared to the control group (mean 547.48 ± 166.9 cc), with a p-value less than 0.001. The trial group showed a statistically significant reduction in the absolute volume of irradiated SB at each dose, ranging from the low dose (10 Gy) to the high dose (45 Gy). In the control group, a negative correlation was found between SB and bladder volumes (R = -0.411, P = 0.008), whereas in the trial group, this correlation was weaker (R = -0.286, P = 0.091), with no significant relationship observed between bladder volume and SB. Conclusion: The high buttocks supine position effectively reduces SB radiation exposure without the need for bladder distension. This positioning method holds promise for reducing SB irradiation in various pelvic tumors. [ABSTRACT FROM AUTHOR]