The purpose was to describe cervical sagittal alignment in adolescent idiopathic scoliosis (AIS) compared to a normal group of adolescents and young adults, seeking for differences by Lenke type. Radiographs of 1779 AIS patients and 1115 controls were analyzed. Lenke types were determined. Spinopelvic parameters, thoracic kyphosis (TK), lumbar lordosis and sagittal vertical axis (SVA) CAM, C2, and C7 were measured. Cervical parameters included McGregor slope, C1–C2 and McGregor–C2 lordosis, C2–C7 lordosis (subdivided into cranial and caudal arches), C7 and T1 slopes. Cervical alignment patterns were classified as lordotic, kyphotic or sigmoid shapes. Lenke 1, 2, 3 and 6 curves showed decreased C2–C7 and caudal arch lordosis associated with decreased C7 and T1 slopes and TK (p < 0.001) compared to normal. Cranial cervical parameters were comparable to the normal group. Lenke 5 patients demonstrated TK, C7 and T1 slopes, and cervical alignment parameters close to the normal group. In AIS, TK correlated with caudal cervical (r = 0.76) and C2-C7 lordosis (r = 0.52), but only weakly with cranial cervical parameters. Cervical sagittal alignment compensatory changes in AIS predominantly involve the caudal cervical segment and are closely related to TK, while cranial alignment remains close to normal, supporting horizontal gaze. As opposed to other AIS types with thoracic deformity, Lenke 5 patients had no cervical compensation, and sagittal alignment was close to normal. Distinguishing normative from pathologic compensation across AIS curve types may help optimize surgical planning and restoration of TK to indirectly improve cervical alignment.
BACKGROUND:Treatment with bepirovirsen, an antisense oligonucleotide targeting hepatitis B virus (HBV) transcripts, has the potential to result in a functional cure, defined by at least 24 weeks of a sustained HBV DNA level below the lower limit of quantification (LLOQ) and hepatitis B surface antigen (HBsAg) loss after fixed-duration therapy. METHODS:In two replicate, double-blind trials (B-Well 1 and B-Well 2), we randomly assigned adults with noncirrhotic chronic HBV infection in a 2:1 ratio to receive subcutaneous bepirovirsen (at a weekly dose of 300 mg) or placebo for 24 weeks. All the patients were receiving stable nucleoside or nucleotide analogue (NA) therapy and had an HBsAg level of more than 100 to 3000 IU per milliliter. Eligible patients discontinued NA therapy at 48 weeks. The primary outcome was a functional cure at week 72. RESULTS:The percentage of patients with a functional cure at week 72 was significantly higher with bepirovirsen than with placebo both in the B-Well 1 trial (in 127 of 650 patients [20%] vs. none of 328 patients) and in the B-Well 2 trial (in 106 of 570 patients [19%] vs. none of 286 patients). In a pooled analysis at 72 weeks, adverse events were reported in 91% of the patients in the bepirovirsen groups and in 73% of those in the placebo groups; serious adverse events were reported in 7% and 4% of the patients, respectively. During the treatment period, adverse events of grade 3 or higher were reported in 16% of the patients who received bepirovirsen and in 3% of those who received placebo; increases in the alanine aminotransferase level were the most common grade 3 adverse events with bepirovirsen (in 6% of the patients). CONCLUSIONS:In two phase 3 trials involving patients with chronic HBV infection, a functional cure after the discontinuation of NA therapy was reported in significantly more patients treated with bepirovirsen than in those who received placebo. (Funded by GSK; ClinicalTrials.gov numbers, NCT05630807 and NCT05630820.).
Chronic Low back pain (CLBP) is a common health concern with various consequences in particular on different aspects of sexual function. This study aimed to assess sexual function in men with chronic degenerative CLBP and to identify factors associated with erectile dysfunction (ED). We conducted a cross-sectional study over a 12-month period. Adult male patients with degenerative CLBP (≥ 3 months duration) of degenerative or disc-related origin were consecutively enrolled. Sociodemographic characteristics and CLBP characteristics (intensity with Visual Analogic Scale (VAS), radicular pain and its pattern…) were collected. Patients with inflammatory rheumatic diseases, prior spinal surgery, or medical conditions known to cause sexual dysfunction were excluded. Sexual function was evaluated using the International Index of Erectile Function (IIEF) and the Sexual Assessment Questionnaire (SAQ). Psychological status, disability, and sleep quality were also evaluated. Multivariate logistic regression was performed to identify factors associated with ED. We included 101 male patients with a mean age of 52.14 ± 12.89 years. Erectile dysfunction (IIEF erectile function domain ≤ 25) was present in 83
BACKGROUND:More high-quality evidence for stent-assisted coiling (SAC) of cerebral aneurysms is needed. Randomized controlled trials have shown lower recurrence with the HydroCoil Embolic System (HES) compared with bare platinum coils, and self-adjudicated LVIS Evo SAC studies have demonstrated favorable safety and technical success. The objective of the SEALANT study is to investigate the safety and effectiveness of this device combination. METHODS:SEALANT is an open-label, prospective, single-arm, multicenter study including patients with aneurysms up to a maximum size of 12 mm. The primary effectiveness endpoint was complete occlusion on digital subtraction angiography (DSA), and the primary safety endpoint was major ipsilateral stroke or neurological death. Adverse events and imaging were independently adjudicated. RESULTS:206 patients were enrolled; 193 had follow-up imaging for outcome assessment; and 164 satisfied all criteria, were treated with both study devices (including ≥90% HES), and had DSA follow-up. The participants' mean age was 56.8±11.6 years; 65% were female. Of 212 aneurysms, 86.3% were bifurcation and 13.2% sidewall; 25.0% were previously treated and 17.9% previously ruptured; 89.6% were anterior circulation, 34.0% at the anterior communicating artery, and 30.7% at the middle cerebral artery; and 84.9% were wide-necked (neck ≥4 mm or dome/neck ratio <2). The primary effectiveness endpoint of complete occlusion was achieved in 82.1% (95% CI 76.4% to 87.9%) of aneurysms. 2.4% (95% CI 0.3% to 4.5%) of patients met the primary safety endpoint of major ipsilateral stroke or neurological death. The primary safety endpoint was significantly associated with baseline modified Rankin Scale and history of previous stroke. CONCLUSION:1-year SEALANT results confirm the safety and effectiveness of SAC using LVIS Evo and HES. TRIAL REGISTRATION NUMBER:NCT04999423.
To validate a previously published CT-based severity score of ischemic colitis and to propose a potential improvement by assessing severity using clinical, biological, and CT criteria. This retrospective single-center study included 174 patients (mean age, 73 ± 12 years; 85 men) with ischemic colitis diagnosed between 2014 and 2023. All underwent contrast-enhanced CT. Severe ischemic colitis was defined by death within 1 month, necrosis at colonoscopy, surgery, or superior mesenteric artery stenting. Clinical, biological, and CT features were compared between severe and non-severe cases. The Montpellier CT severity score was applied to the cohort. Logistic regression was used to test additional CT predictors and to propose a modified score. Among 174 patients, 97 (56
