AIM: To observe the clinical features and the surgical outcomes of the high myopic (HM) patients with epiretinal membranes (ERM). METHODS: This was a retrospective study enrolled HM patients diagnosed with ERM who underwent vitrectomy between May 2012 and November 2021. Three groups were divided according to axial length (AXL): 26–<28 mm (n=43), 28–<30 mm (n=22), and ≥30 mm (n=11). Baseline characteristics and postoperative visual and anatomical outcomes were analyzed. RESULTS: Totally 76 consecutive eyes of 73 HM patients (27 males), with a mean age of 60.5±9.2y (range: 38–84y) were enrolled. The initial best-corrected visual acuity (BCVA) of the three groups was not significantly different (P=0.498). Longer AXL was associated with a higher incidence of both inner and outer macular retinoschisis (MRS), ellipsoid zone (EZ) disruption, and foveal retinal detachment (all P<0.05). Only the eyes in the 26–<28 mm group showed a significant improvement in postoperative BCVA. BCVA was improved in 77.6% of the eyes. Among the eyes with BCVA not improved, 58.8% belonged to the group 26–<28 mm. The postoperative macular hole was seen in 1 (1.32%) eye. Multivariate linear regression analysis indicated that initial BCVA (P<0.001) and epiretinal proliferation (P=0.010) influenced the final BCVA. CONCLUSION: AXL is not significantly associated with visual recovery. Early operative intervention might have better visual and anatomical outcomes in HM-ERM patients.

Background:X-linked ichthyosis (XLI) and X-linked retinoschisis (XLRS) are both inherited in an X-linked recessive manner. To date, no prior reports document both conditions' simultaneous occurrence. This case presents two brothers who were diagnosed with XLI combined with XLRS in a family. Case presentation:An 11-year-old boy (Case 1) presented to our hospital due to decreased bilateral vision detected during a physical examination over the past month. One month after birth, the parents noticed the child's skin was dry and rough. He was diagnosed with "ichthyosis" at another hospital, and after treatment, the condition improved. His mother had also been previously diagnosed with ichthyosis. The child was a full-term infant delivered by cesarean section, and his parents were not closely related. There was no family history of eye disease. Physical examination showed dry skin with diamond-shaped scales. The best-corrected visual acuity was 0.40 logMAR in both eyes. No abnormalities were observed in the anterior segments of both eyes. Fundus examination revealed petaloid macular edema, and OCT showed numerous cystic changes in the macular area of both eyes. His 6-year-old younger brother (Case 2) exhibited similar systemic and ocular features. Comprehensive ophthalmic and genetic examinations were performed on the entire family, revealing that both children carried an RS1 gene mutation, with the mutation site at c.545G>T/p.Arg182Leu, inherited from their mother. Additionally, a deletion variant of approximately 478 kb was found at the X chromosome p22.31 location, completely covering the STS gene region. Based on the genetic testing and ocular examination, both children were finally diagnosed with bilateral XLRS and XLI. Conclusion:This case expands the mutation spectrum of XLRS in Chinese patients and, for the first time, reports the ocular and systemic manifestations when two different disease genes, STS and RS1, coexist. The family members vividly demonstrate the phenotypic and genotypic individual heterogeneity associated with hereditary eye diseases. A comprehensive analysis of clinical phenotype and genotype improves clinical diagnosis and genetic testing accuracy, providing a clinical approach for a more comprehensive understanding of the disease.

Rationale: To report a rare case of primary hyperaldosteronism initially presenting with bilateral branch retinal vein occlusion (BRVO).Patient concerns: Having a 17-year history of poorly controlled hypertension, a 62-year-old male patient suffered from recurrent macular edema secondary to bilateral BRVO.Diagnoses: Laboratory tests revealed elevated plasma aldosterone concentration, lowered direct renin concentration, and an augmented aldosterone-to-renin ratio, with no suppression of plasma aldosterone on the Captopril test (15.2 ng/dL to 16.1 ng/dL). Diagnosis of bilateral BRVO with recurrent macular edema was further confirmed by ocular imaging, which predominantly comprised optical coherence tomography and fluorescein angiography.Interventions: The patient received systemic antihypertensive therapy. Ocular treatment included multiple intravitreal anti-vascular endothelial growth factor injections and dexamethasone implants.Outcomes: In the aftermath of combined systemic and intravitreal therapy, blood pressure was controlled, and the condition remained acceptably stable throughout follow-up.Lessons: This case sufficiently underscored the significance of systemic screening in patients with BRVO, especially those with refractory hypertension. It has been proven to be effective when systemic and intravitreal therapy are integrated, and long-term management is essential for the clinical treatments.

To describe the clinical characteristics and visual and anatomical surgical prognosis for full-thickness macular hole (FTMH) secondary to retinal vein occlusion (RVO). This retrospective study reviewed 13 eyes from 13 consecutive patients with FTMH after RVO who underwent pars plana vitrectomy (PPV) combined internal limiting membrane (ILM) peeling or ILM flap insertion. Clinical demographics and spectral-domain optical coherence tomography (SD-OCT) features were evaluated. Multiple linear regression was used to analyze the associated factors for the final best-corrected visual acuity (BCVA). Of the 13 eyes, 11 had a previous branch RVO (BRVO) and 2 had a central RVO (CRVO). The mean minimum linear diameter (MLD) of these secondary macular holes was 469.31 ± 197.96 μm. Eight subjects (61.5

Introduction: The outcomes and prognosis of pars plana vitrectomy (PPV) for high myopia-epiretinal membrane (HM-ERM) patients with retinoschisis remains unclear. The aim of this study was to analyze the impact of retinoschisis on the recovery of macular configuration and visual acuity following ERM removal in eyes with HM and to explore the prognostic factors. Methods: A retrospective study of 73 consecutive patients with HM-ERM who underwent PPV with ERM peeling. According to the optical coherence tomography images, eyes were classified into 4 groups: group A without retinoschisis, group B with outer retinoschisis, group C with inner retinoschisis, and group D with both inner and outer retinoschisis. Results: In groups A, B, C, and D, there were 17, 21, 22, and 16 eyes, respectively. Retinoschisis of 44 eyes (74.6%) disappeared postoperatively, including 11 eyes in group B, 20 in group C, and 8 in group D. No correlation was found between retinoschisis resolution and baseline factors. The mean best corrected visual acuity (BCVA) significantly improved at the final follow-up (p < 0.001). The final BCVA was associated with baseline BCVA (p = 0.001), the presence of epiretinal proliferation preoperatively (p = 0.014), and the postoperative integrity of the ellipsoid zone (EZ) (p = 0.001) and interdigitation zone (IZ) (p = 0.008). Conclusions: After surgery, the inner retinoschisis usually resolved completely. Retinoschisis was not the main factor influencing final BCVA. Preoperative BCVA and disruption of EZ and IZ were associated with good visual recovery in long-term follow-up.

Purpose: To investigate the anatomical and visual outcomes of inverted internal limiting membrane flap insertion versus single-layered i-internal limiting membrane flap covering in highly myopic macular holes associated with macular retinoschisis. Methods: A retrospective study compared 23 G vitrectomy with inverted-internal limiting membrane flap insertion (30 eyes) or covering (31 eyes) in highly myopic macular holes patients. Pre- and postoperative optical coherence tomography images and best-corrected visual acuity (BCVA) were evaluated. Macular hole schisis was classified into three types based on the extent of outer layer schisis. Regression analysis identified predictors of closure rate and postoperative BCVA. Results: The baseline data of the two groups were matched, including BCVA, axial length, and minimum linear diameter, except for a higher hole height in insertion group (P = 0.038). After a mean follow-up of 11.7 months, type I closure rates were 83.3% (25/30) in the insertion group and 90.3% (28/31) in the covering group (P = 0.335), respectively. The intact external limiting membrane in the covering group (7/28) was higher compared with the insertion group (1/28) finally (P = 0.026). Final BCVA improved significantly in both groups (P < 0.001); the BCVA was better in closed highly myopic macular holes in the covering group (P = 0.011). Multivariate linear regression analysis revealed that preoperative BCVA (β = 0.386, P = 0.001) and Macular hole schisis stage (β = 0.309, P = 0.004) were independent predictive factors for the final BCVA. Conclusion: The single-layered inverted-internal limiting membrane flap covering favored foveal structure recovery and provided a better visual prognosis in closed highly myopic macular holes compared with insertion. The preoperative BCVA and macular hole schisis stage were independent predictors of visual outcomes in patients with highly myopic macular holes.

High-grade serous ovarian cancer (HGSOC) is an aggressive gynecological malignancy marked by widespread metastasis, most notably to the omentum. However, the molecular mechanisms driving this process remain poorly understood. We present an integrated analysis of single-cell RNA sequencing (scRNA-seq) data from normal ovaries, primary tumors, and omental metastases to generate a high-resolution cellular landscape of HGSOC. LAPTM5 expression was examined by immunohistochemistry, immunofluorescence, qPCR, western blotting, and analyses of TCGA datasets. Functional assays including Transwell migration/invasion, wound healing, flow cytometry, single-nucleotide variant (SNV) and alternative splicing (AS) analysis were performed after LAPTM5 knockdown. The proteins expression involved in epithelial-mesenchymal transition (EMT) and TGF-β mediated signaling pathways was verified by qPCR and western blotting. The critical role of LAPTM5 on metastasis in vivo was detected by the tumor-bearing mice model. We identified a metastasis-associated epithelial subcluster characterized by immune suppression and poor prognosis, with LAPTM5 emerging as a defining marker. Functional assays revealed that LAPTM5 silencing significantly impaired HGSOC cell migration, invasion, and epithelial-mesenchymal transition (EMT) in vitro, and reduced metastatic burden in vivo. Mechanistically, LAPTM5 activates the TGF-β/Smad signaling pathway, promoting EMT and facilitating omental metastasis. Intriguingly, LAPTM5 knockdown led to reduced single-nucleotide variant (SNV) accumulation and alternative splicing (AS) events, thereby decreasing the expression of metastasis-associated genes. These findings identify LAPTM5 as a key regulator of TGF-β/Smad-driven epithelial plasticity and omental dissemination in HGSOC, positioning it as both a prognostic biomarker and a potential therapeutic target for advanced-stage disease.

Background: Retroperitoneal liposarcoma (RPLS) is a critical malignant disease with various clinical outcomes. However, the molecular heterogeneity of RPLS was poorly elucidated, and few biomarkers were proposed to monitor its progression. Methods: RNA sequencing was performed on a training cohort of 88 RPLS patients to identify dysregulated genes and pathways using clusterProfiler. The GSVA algorithm was utilized to assess signaling pathway levels in each sample, and unsupervised clustering was employed to distinguish RPLS subtypes. Differentially expressed genes (DEGs) between RPLS subtypes were identified to construct a simplified dichotomous clustering via nonnegative matrix factorization. The feasibility of this classification was validated in a separate validation cohort (n=241) using immunohistochemistry (IHC) from the REtroperitoneal SArcoma Registry (RESAR). The study is registered with https://clinicaltrials.gov/ under number NCT03838718. Results: Cell cycle, DNA damage and repair, and metabolism were identified as the most aberrant biological processes in RPLS, enabling the division of RPLS patients into two distinct subtypes with unique molecular signatures, tumor microenvironment, clinical features, and outcomes (overall survival [OS] and disease-free survival [DFS]). A simplified RPLS classification based on representative biomarkers (LEP and PTTG1) demonstrated high accuracy (area under the curve [AUC]>0.99), with patients classified as LEP+ and PTTG1-, showing lower aggressive pathological composition ratio and fewer surgery times, along with better OS (HR = 0.41, p<0.001) and DFS (HR = 0.60, p=0.005). Conclusions: Our study provided an ever-largest gene expression landscape of RPLS and established an IHC-based molecular classification that was clinically relevant and cost-effective for guiding treatment decisions. Funding: This work was supported by grants from the Beijing Municipal Science and Technology Project (Z191100006619081), National Natural Science Foundation of China (82073390), and Young Elite Scientists Sponsorship Program (2023QNRC001). The study sponsors had no role in the design and preparation of this manuscript. Clinical trial number: NCT03838718

Purpose: Platinum-based chemotherapy is effective but limited by resistance in high-grade serous ovarian cancer (HGSOC). Single-cell RNA sequencing (scRNA-seq) can reveal tumour cell heterogeneity and subclonal differentiation. We aimed to analyze resistance mechanisms and potential targets in HGSOC using scRNA-seq. Methods: We performed 10× genomics scRNA-seq sequencing on tumour tissues from 3 platinum-sensitive and 3 platinum-resistant HGSOC patients. We analyzed cell subcluster communication networks and spatial distribution using cellchat. We performed RNA-seq analysis on TACSTD2, a representative resistance gene in the E0 subcluster, to explore its molecular mechanism. Results: Epithelial cells, characterized by distinct chemotherapy resistance traits and highest gene copy number variations, revealed a specific cisplatin-resistant cluster (E0) associated with poor prognosis. E0 exhibited malignant features related to resistance, fostering growth through communication with fibroblasts and endothelial cells. Spatially, E0 promoted fibroblasts to protect tumour cells and impede immune cells infiltration. Furthermore, TACSTD2 was identified as a representative gene of the E0 subcluster, elucidating its role in platinum resistance through the Rap1/PI3K/AKT pathway. Conclusions: Our study reveals a platinum-resistant epithelial cell subcluster E0 and its association with TACSTD2 in HGSOC, uncovers new insights and evidence for the platinum resistance mechanism, and provides new ideas and targets for the development of therapeutic strategies against TACSTD2+ epithelial cancer cells.

Introduction: The aim of this study was to evaluate the clinical characteristics and surgical outcomes of the epiretinal membrane foveoschisis (ERM-FS) with different morphological types. Methods: This retrospective observational study reviewed 44 consecutive ERM-FS patients who underwent ERM surgery. According to the optical coherence tomography images, ERM-FS was classified into three groups: group A, FS crossed the fovea with the foveola elevated; group B, FS located at the foveal edges with a near-normal central foveal point thickness; and group C, FS with undermined foveal edges with a near-normal central foveal point thickness. Results: There were 10 eyes in group A, 20 eyes in group B, and 14 eyes in group C. Preoperatively, eyes in group A had the best best-corrected visual acuity (BCVA), the thickest central foveal point thickness, and the highest ellipsoid zone (EZ) intact rate among the three groups. After surgery, a resolution of foveoschisis was observed in 40.0%, 45.0%, and 50.0% of the eyes in group A, group B, and group C (p = 0.928), respectively. BCVA was significantly improved postoperatively. Although there was no significant difference in BCVA among the three groups at 1 month postoperatively, BCVA of group A was the best at 4 and 10 months. Correlation analysis indicated that the type of ERM-FS, baseline BCVA, central foveal point thickness, and postoperative EZ continuity (all p < 0.05) were important factors for the final BCVA. Conclusions: The damage to the retinal structure and visual function was milder in group A ERM-FS. Our study emphasized the necessity of OCT-based subtyping in patients with ERM-FS.

PURPOSE:To investigate the predictive factors for postsurgical visual prognosis in patients with vitreomacular traction (VMT). METHODS:This retrospective study enrolled 31 eyes from 29 patients who underwent vitrectomy for idiopathic VMT with a follow-up period of ≥3 months. The VMT was divided into three grades based on optical coherence tomography images: Grade 1 denoted partial vitreomacular separation with foveal attachment; Grade 2 exhibited intraretinal cysts or cleft with grade 1 findings; and Grade 3 was Grade 2 plus the subretinal fluid. RESULTS:Three eyes developed a full-thickness macular hole after surgery, all of which were Grade 3 patients. In the rest 28 eyes, the mean postoperative follow-up period was 23.3 ± 25.8 months. The postoperative central foveal thickness ( P = 0.001) and final best-corrected visual acuity (BCVA; P < 0.001) were both significantly improved from baseline. Fifteen eyes (53.8%) gained ≥ two Snellen lines. Multilinear regression analysis showed that the worse the baseline BCVA ( P = 0.004), or the more advanced the VMT grade ( P = 0.049), the worse the final BCVA. Baseline BCVA was negatively associated with the postoperative visual improvement ( P < 0.001). Those Grade 3 patients with baseline Snellen BCVA of ≥20/40 were more likely to achieve a final Snellen BCVA of ≥20/25 ( P = 0.035). CONCLUSION:The VMT grade is an important predictive factor for the postsurgical visual prognosis. Surgical intervention should be performed as early as possible for Grade 3 patients to prevent further disease progression and maximize the postsurgical visual benefit.

Retinal artery occlusions are rare amongst young adults, and relevant risk factors and etiology remain unclear. In this report, we present a case of central retinal artery occlusion (CRAO) as the initial manifestation of mixed connective tissue disease (MCTD) in a young woman. A 22-year-old female presented to the emergency department with a sudden decrease in visual acuity in her right eye for 1 hour. She reported a similar episode in her left eye five years prior, which resolved spontaneously after 2 hours. Initially misdiagnosed with optic neuritis in the right eye at another hospital, she was referred to our institution the following day. Clinical examination revealed a CRAO in her right eye. A detailed medical history revealed that she had developed livedo reticularis (LR) on both lower limbs five years ago, which had been overlooked and untreated. Further rheumatologic history, hematologic tests, and an autoimmune work-up confirmed a diagnosis of mixed connective tissue disease (MCTD). In young patients presenting with CRAO, further examinations should be conducted to investigate systemic disease or an embolic source to prevent future sequelae.

Abstract Background The internal limiting membrane (ILM) insertion technique was widely used to treat large macular hole (MH) for the high closure rate. However, the prognosis of closed MH after ILM insertion compared to ILM peeling remains controversial. This study aimed to compare foveal microstructure and microperimeter in large idiopathic MH surgically closed by ILM peeling and ILM insertion. Methods This retrospective, non-randomized, comparative study included patients with idiopathic MH (minimum diameter ≥ 650 μm) who underwent primary pars plana vitrectomy (PPV) with ILM peeling or ILM insertion. The initial closure rate was recorded. Patients with initially closed MHs were divided into two groups according to the surgery methods. The best-corrected visual acuity (BCVA), optical coherence tomography (OCT) and microperimeter-3 (MP-3) outcomes of two groups were compared at baseline, 1 and 4 months postoperatively. Results For idiopathic MH (minimum diameter ≥ 650 μm), ILM insertion had a significantly higher initial closure rate than ILM peeling (71.19% vs. 97.62%, P = 0.001). Among 39 patients with initially closed MHs who were on regular follow-up, twenty-one were assigned to the ILM peeling group and 18 to the ILM insertion group. Postoperative BCVA improved significantly in both groups. The final BCVA (logMAR) (0.40 vs. 0.88, P < 0.001), macular hole sensitivity (19.66 dB vs. 14.14 dB, P < 0.001), peripheral sensitivity of macular hole (24.63 dB vs. 21.95 dB, P = 0.005), and fixation stability (FS) within 2 degrees (82.42% vs. 70.57%, P = 0.031) were significantly better and external limiting membrane (ELM) defect (330.14 μm vs. 788.28 μm, P < 0.001) and ellipsoid zone (EZ) defect (746.95 μm vs. 1105.11 μm, P = 0.010) were significantly smaller in the ILM peeling group than in the ILM insertion group. Conclusion For initially closed MHs (minimum diameter ≥ 650 μm), both ILM peeling and ILM insertion significantly improved the microstructure and microperimeter in the fovea. However, ILM insertion was less efficient at microstructural and functional recovery after surgery.

INTRODUCTION:During macular hole (MH) formation, the vitreofoveal traction may lead to foveal neural tissue avulsion and consequent photoreceptor loss. However, the clinical significance of the photoreceptor outer segment disruption at the MH border remains unclear. This study aims to investigate the clinical features and surgical outcomes of MHs with photoreceptor outer segment disruption at the MH border.METHODS:This study retrospectively reviewed 86 eyes from 85 patients who underwent vitrectomy combined with internal limiting membrane peeling for idiopathic MHs. Baseline and postoperative best-corrected visual acuity (BCVA) and foveal microstructure on optical coherence tomography images were compared between eyes with smooth and bumpy morphology, the latter of which was defined as those with an uneven and irregular surface with evident lumps and indentations at the MH border.RESULTS:The bumpy morphology was identified in 59 of 86 eyes (68.9%). At baseline, eyes with a bumpy MH morphology had a significantly larger minimum linear diameter (p = 0.043), a longer external limiting membrane defect (p = 0.013), and a worse baseline BCVA (p = 0.017) than those with a smooth morphology. Postoperatively, in a multivariate regression model adjusting preoperative confounding effects, eyes with bumpy borders were associated with a longer ellipsoid zone defect (p = 0.006) and a thinner central fovea (p = 0.002) at 1 month, and a thinner central fovea (p = 0.005) and a worse BCVA (p = 0.015) at 10 months.CONCLUSION:A severe photoreceptor outer segment loss is common at the MH border, which represents a chronic pathogenic process and may be an independent predictor for an incomplete photoreceptor recovery and worse long-term visual outcomes after surgery.

Colorectal cancer (CRC) is the second leading cause of cancer‐related death worldwide. Many molecular classification strategies are proposed for CRC but few studies include survival data in their models. Herein a prognosis‐oriented CRC classifier is constructed by adapting the natural partially labeled censored survival data into a customized semi‐supervised learning algorithm, which is called Monte‐Carlo K‐nearest neighbor voting (MC‐KV) classifier. Three CRC subtypes with distinct prognoses are identified by this classifier using the data from the cancer genome atlas. Furthermore, a six‐gene risk model is constructed by combining weighted gene coexpression network analysis and least absolute selection and shrinkage operator for variable selection and four algorithms (random survival forest, support vector machine, Adaboost, and logistic regression) for optimization. The optimized model shows great performance in distinguishing high‐risk from low‐risk patients with a maximum area under curve of 0.869, 0.906, and 0.921 in 1‐, 3‐, and 5‐year survival, respectively. Additionally, the six‐gene signature identified by MC‐KV exhibits great predictive efficiency for other cancer types. Overall, a tool, Monte‐Carlo K‐nearest neighbor voting (MC‐KV), is provided to identify molecular subtyping of CRC, which suggests the potential contribution of semi‐supervised algorithms and the inclusion of patient‐level survival data in cancer classification.

Allosteric mechanisms in human cytochrome P450 3A4 (CYP3A4) in oligomers in solution or monomeric enzyme incorporated into Nanodiscs (CYP3A4ND) were studied by high-pressure spectroscopy. The allosteric substrates 1-pyrenebutanol (1-PB) and testosterone were compared with bromocriptine (BCT), which shows no cooperativity. In both CYP3A4 in solution and CYP3A4ND, we observed a complete pressure-induced high-to-low spin shift at pressures of <3 kbar either in the substrate-free enzyme or in the presence of BCT. In addition, both substrate-free and BCT-bound enzyme revealed a pressure-dependent equilibrium between two states with different barotropic parameters designated R for relaxed and P for pressure-promoted conformations. This pressure-induced conformational transition was also observed in the studies with 1-PB and testosterone. In CYP3A4 oligomers, the transition was accompanied by an important increase in homotropic cooperativity with both substrates. Surprisingly, at high concentrations of allosteric substrates, the amplitude of the spin shift in both CYP3A4 in solution and Nanodiscs was very low, demonstrating that hydrostatic pressure induces neither substrate dissociation nor an increase in the heme pocket hydration in the complexes of the pressure-promoted conformation of CYP3A4 with 1-PB or testosterone. These findings suggest that the mechanisms of interactions of CYP3A4 with 1-PB and testosterone involve an effector-induced transition that displaces a system of conformational equilibria in the enzyme toward the state(s) with decreased solvent accessibility of the active site so that the flux of water into the heme pocket is impeded and the high-spin state of the heme iron is stabilized.

"BIO23-020: A Novel Semi-Supervised Learning Algorithm for Prognosis-Oriented Classification and Biomarker Identification of Colorectal Cancer" published on 31 Mar 2023 by National Comprehensive Cancer Network.

PURPOSE:To investigate the clinical features and surgical outcomes of idiopathic macular holes with epiretinal proliferation (EP).METHODS:This retrospective study included 282 eyes of 269 consecutive patients who underwent vitrectomy for idiopathic macular holes. Clinical demographic data, baseline and postoperative retinal microstructure features on optical coherence tomography images, best-corrected visual acuity, and postoperative closure rate were compared between eyes with and without EP.RESULTS:EP was identified in 38 of 282 eyes (13.5%). Eyes with EP had a significantly longer symptom duration ( P = 0.019), higher frequency of pseudophakic conditions ( P = 0.034), presence of epiretinal membrane ( P < 0.001), and a larger base diameter ( P = 0.014) than those without EP. In addition, compared with eyes without EP, those with EP had a higher percentage of U-type closure ( P = 0.047) and a thicker central fovea ( P = 0.012) at 1 month postoperatively and a significantly lower frequency of ellipsoid zone disruption ( P = 0.033) and outer foveolar lucency ( P = 0.021) and a thicker central fovea ( P = 0.004) at 10 months postoperatively.CONCLUSION:The presence of EP represents a more chronic pathogenic process but has no negative effect on postoperative outcomes and can even facilitate anatomical recovery after surgery.