Schizophrenia is a chronic psychiatric disorder severely affecting patients\' functioning and quality of life. Unlike positive symptoms, cognitive impairment and negative symptoms cannot be treated pharmacologically and represent consistent predictors of the illness\'s prognosis. Cognitive remediation (CR) interventions have been applied to target these symptoms. Brain stimulation also provides promising yet preliminary results in reducing negative symptoms, whereas its effect on cognitive impairment remains heterogeneous. Here, we combined intermittent theta burst stimulation (iTBS) with CR to improve negative symptoms and cognitive impairment in schizophrenia spectrum patients. One hundred eligible patients were invited, and twenty-one participated. We randomized them into four groups, manipulating the stimulation condition (real vs. sham) and CR (no training vs. training). We delivered fifteen iTBS sessions over the left dorsolateral prefrontal cortex for three weeks, followed (or not) by 50 min of training. Consensus-based clinical and cognitive assessment was administered at baseline and after the treatment, plus at three follow-ups occurring one, three, and six months after the intervention. Mixed-model analyses were run on cognitive and negative symptom scores. The preliminary findings highlighted a marginal modulation of iTBS on negative symptoms, whereas CR improved isolated cognitive functions. We herein discuss the limitations and strengths of the methodological approach.

Hip dislocation is rare, and it typically results from high-energy trauma such as traffic accidents. Its management involves prompt reduction of the dislocated hip to minimize the risk of subsequent femoral head necrosis. Consequently, cases of chronic hip dislocation are extremely rare. This report presents a case of a 33-year-old male with chronic posterior hip dislocation due to a traffic accident 13 years ago. The left femoral head was completely dislocated posteriorly from the acetabulum, forming a false acetabulum with an arthritic change. The patient experienced difficulty walking and performing daily activities due to pain. We performed a total hip arthroplasty (THA) using a combined anterolateral and posterior approach. The outcome was favorable, with no complications during the two-year follow-up period. THA using a combined anterolateral and posterior approach is a valuable option for patients with chronic post-traumatic hip dislocation because it offers the advantages of optical visibility and the management of the adhered soft tissues.

CONCLUSIONS: Complications in combined surgery are equivalent to ESS but are higher than rhinoplasty alone. The most common complications are pneumonia, stroke, and epistaxis. Rhinoplasty surgeries with graft use have a higher risk of complications.

Facelift surgery, also known as rhytidectomy, is a popular cosmetic procedure aimed at reversing the signs of facial aging. While facelift surgery is more commonly performed in women, an increasing number of men are seeking this procedure to maintain a youthful appearance. The long recovery period conflicts the overall primary outcome anticipated by men undergoing rhytidectomy, i.e., appear younger, youthful, and ready to reaffirm their value in the working environment. Anterior direct neck lift, blepharoplasty (upper and lower eyelid blepharoplasty), and lipofilling are three techniques that have been shown to be effective in improving facial rejuvenation outcomes in elderly male patients. However, there is little to no evidence of the safety and efficacy of these techniques when used in combination. By combining these techniques, we hypothesized that we could achieve outcomes comparable to traditional facelift surgery, but with a lower risk of complications and a shorter recovery time. We conducted a retrospective case series study of 18 male patients who underwent facial rejuvenation surgery using the combination of anterior direct neck lift, blepharoplasty (upper and lower eyelid blepharoplasty), and lipofilling at our institution between 2018 and 2021. All 18 patients completed the study, with an average follow-up of 12 months. No major complications were observed, and all patients reported a high level of satisfaction with their outcomes.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

暂无摘要。

Coronal-plane intra-articular fractures of the femoral condyle (Hoffa fractures) are rare, and difficult to diagnose and treat. They mostly result as a consequence of high-energy trauma and are combined with concomitant fractures (patellar, tibia shaft) and/or soft-tissue damage. A plain X-ray can miss the diagnosis initially and therefore computerized tomography scan is recommended, which can also help in the preoperative planning. The vast majority of these fractures are unicondylar (mostly lateral condyle fractured). The approach for their treatment can be anterior or posterior. In cases of fracture comminution, much more mutilant approaches with osteotomy have been described. A combined two-stage approach can be used to obtain anatomical reduction and fixation of all the fragments. We present a case of a 46-year-old male patient with comminuted lateral Hoffa fracture treated with a combined approach (extended posterior approach to the proximal tibia and lateral parapatellar) in a time interval of one month.

UNASSIGNED: Giant (with a diameter of at least 40 mm and a volume of at least 10 cm3) pituitary adenomas (GPAs) are intricate tumors that pose considerable difficulty for surgical removal. While endoscopic transsphenoidal surgery (ETS) is a commonly employed technique for these destructive tumors, its effectiveness may be restricted in cases where invasion into multiple compartments is present, leading to limited resection.
UNASSIGNED: A retrospective review was conducted on the clinical records of 94 patients diagnosed with GPAs who had undergone surgical resection from 2014 to 2022. An analysis was conducted on the outcomes of the surgical and clinical procedures.
UNASSIGNED: In this group, the average size of the tumor before surgery was 44.6 ± 5.6 mm (range, 40-73 mm), and the volume was 25. 5± 16.6 cm3 (range, 10-20.67 cm3). Of the total number of patients, 72 (76.6%) underwent a single ETS, 12 (12.8%) opted for transcranial surgery (TCS), and 10 (10.6%) chose a combined method. Gross total resection (GTR) was successfully performed in 49 (68.1%), 3 (25.0%), and 8 (80.0%) patients who underwent each surgical approach. Seventy-four (78.7%) patients had improved vision, 20 (21.3%) were unchanged, and none had deterioration. Twenty-two patients (23.4%) experienced a total of 43 complications, which comprised hormonal insufficiency (11/94, 11.7%), diabetic insipidus (6/88, 6.8%), electrolyte disorders (7/94, 7.4%), cerebrospinal fluid leakage (5/94, 5.3%), meningitis (8/94, 8.5%), and hydrocephalus (6/94, 6.4%). The GTR, subtotal resection (STR), and partial resection (PTR) rates were 63.8% (60/94), 21.3% (20/94), and 14.9% (14/94), respectively. Throughout the follow-up duration, 18.1% (17/94) of patients required reoperation and/or adjuvant radiation treatment as a result of tumor regrowth or inadequate biochemical remission of functioning GPAs.
UNASSIGNED: ETS remains the optimal surgical option for most GPAs and generally offers safe and efficient tumor resection. However, a combined approach with TCS remains a requirement in cases that are not suitable for treatment with a single ETS. To achieve optimal tumor removal and minimize the occurrence of surgical complications, a flexible combination of ETS and TCS is recommended based on the characteristics of the tumor.

UNASSIGNED: To compare the effectiveness between the posterolateral approach and the posterolateral combined posteromedial approaches in the treatment of Mason type 2B posterior malleolar fracture.
UNASSIGNED: A retrospective analysis was performed on the clinical data of 79 patients with posterior ankle fracture who met the selection criteria between January 2015 and January 2022. There were 62 cases of Mason 2B Pilon subtype and 17 cases of avulsion subtype. Among Mason 2B Pilon subtype patients, 35 were treated with posterolateral approach (group A), 27 patients were treated with combined approach (group B). There was no significant difference in gender, age, injured side, cause of injury, time from injury to operation, preoperative hospital stay, preoperative visualanalogue scale (VAS) score, and intraoperative internal fixation between the two groups ( P>0.05). All patients with Mason 2B avulsion subtype were treated by posterolateral approach, including 7 males and 10 females, aged from 25 to 68 years, with an average of 46.1 years. The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The reduction quality was evaluated by Ovadia deals radiographic score, and the ankle function and pain were evaluated by VAS score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and ankle range of motion.
UNASSIGNED: Mason 2B Pilon subtype: There was no significant difference in operation time, intraoperative blood loss, postoperative hospital stay, and follow-up time between the two groups ( P>0.05). The radiological evaluation of Ovadia deals in group A was significantly worse than that in group B ( P<0.05). The VAS score in the two groups significantly improved at each time point after operation, and the VAS score and AOFAS score further improved with the extension of time after operation, and the differences were significant ( P<0.05). Except that the AOFAS score of group A was significantly lower than that of group B at last follow-up ( P<0.05), there was no significant difference in VAS score and AOFAS score between the two groups at other time points ( P>0.05). At last follow-up, the ankle range of motion in group A was significantly less than that in group B ( P<0.05). There was no significant difference in the incidence of sural nerve injury, deep tissue infection, limitation of toe movement, and traumatic ankle arthritis between the two groups ( P>0.05). Mason 2B avulsion subtype: The operation time was (119.47±20.61) minutes and the intraoperative blood loss was 50 (35, 55) mL. Seventeen patients were followed up 13-25 months, with an average of 18 months. The Ovadia deals score was excellent in 10 cases, good in 6 cases, and poor in 1 case at 1 week after operation, and the excellent and good rate was 94.1%. All fractures healed in 8-18 weeks with an average of 12.35 weeks. There were 1 case of sural nerve injury and 3 cases of traumatic ankle arthritis after operation. No deep tissue infection or limitation of toe movement occurred. The VAS score decreased significantly and AOFAS score increased significantly with time, and the differences were significant between different time points before and after operation ( P<0.05). The ankle range of motion at last follow-up was (56.71±2.47)°.
UNASSIGNED: Compared with the posterolateral approach, the combined approach is a better choice for the treatment of Mason 2B Pilon subtype. If the posteromedial bone block does not affect the reduction of the medial malleolus, the posterolateral approach can achieve good effectiveness for Mason 2B avulsion subtype.
UNASSIGNED: 探讨并比较后外侧入路与后外侧联合后内侧入路治疗踝关节骨折中合并Mason 2B型后踝骨折的临床疗效。.
UNASSIGNED: 回顾分析2015年1月—2022年1月收治且符合选择标准的79例后踝骨折患者临床资料。其中Mason 2B Pilon亚型62例、撕脱亚型17例。Mason 2B Pilon亚型患者中，35例采用后外侧入路（A组），27例采用联合入路（B组），两组患者性别、年龄、受伤侧别、致伤原因、受伤至手术时间、术前住院时间、术前疼痛视觉模拟评分（VAS）及术中内固定方式等基线资料比较差异均无统计学意义（ P>0.05）。Mason 2B撕脱亚型患者均采用后外侧入路，其中男7例，女10例；年龄25～68岁，平均46.1岁。记录手术时间、术中出血量、术后住院时间及并发症发生情况；采用Ovadia deals放射学评分评估复位质量，VAS评分、美国矫形足踝协会（AOFAS）评分及踝关节活动度进行功能评价。.
UNASSIGNED: Mason 2B Pilon亚型：两组手术时间、术中出血量、术后住院时间及随访时间比较差异均无统计学意义（ P>0.05）。术后1周内影像学复查示，A组Ovadia deals放射学评分差于B组（ P<0.05）。术后各时间点两组VAS评分均较术前显著改善，术后随时间延长VAS评分和AOFAS评分均进一步改善，差异有统计学意义（ P<0.05）。除末次随访时A组AOFAS评分小于B组（ P<0.05）外，两组间其余时间点VAS评分和AOFAS评分比较差异均无统计学意义（ P>0.05）。末次随访时，A组踝关节活动度小于B组（ P<0.05）。在并发症方面，两组腓肠神经损伤、深部组织感染、踇趾活动受限及创伤性踝关节炎发生率比较差异均无统计学意义（ P>0.05）。Mason 2B撕脱亚型：手术时间（119.47±20.61）min，术中出血量50（35，55）mL。17例患者均获随访，随访时间13～25个月，平均18个月。术后1周测量Ovadia deals放射学评分获优10例、良6例、差1例，优良率94.1%。所有骨折均获骨性愈合，愈合时间8～18周，平均12.35周。术后发生腓肠神经损伤1例，创伤性踝关节炎3例，无深部组织感染、踇趾活动受限发生。随时间延长，VAS评分显著下降，AOFAS评分显著增加，手术前后各时间点间差异均有统计学意义（ P<0.05）。末次随访时踝关节活动度为（56.71±2.47）°。.
UNASSIGNED: 与后外侧入路相比，联合入路对骨折复位质量更优，远期随访功能更佳，是治疗Mason 2B Pilon亚型的较好选择；对于Mason 2B撕脱亚型，若后内侧骨块不影响内踝复位，仅后外侧入路即可获得较好的临床疗效。.

Ependymomas are glial cell tumors whose recommended treatment, according to the recent European guidelines, is surgical. Patient outcomes, in terms of progression-free survival and overall survival, are strongly related to the extent of resection. However, in some cases, critical locations and/or large dimensions could make a gross total resection challenging. In this article, we describe the surgical anatomy and technique of a combined telovelar-posterolateral approach for the resection of a giant posterior fossa ependymoma.
A 24-year-old patient who presented to our institution complaining of a 3-month history of headache, vertigo, and imbalance. Preoperative MRI scans showed a large mass within the fourth ventricle, extending towards the left cerebellopontine angle and perimedullary space through the homolateral Luschka foramen. Surgical treatment was proposed with the aims of releasing the preoperative symptoms, obtaining the tumor\'s histopathological and molecular definition, and preventing any future neurological deterioration. The patient gave his written consent for surgery and consented to the publication of his images. A combined telovelar-posterolateral approach was then performed to maximize the tumor\'s exposure and resection. Surgical technique and anatomical exposure have been extensively described, and a 2-dimensional operative video has been included.
The postoperative MRI scan demonstrated an almost complete resection of the lesion, with only a millimetric tumor remnant infiltrating the uppermost portion of the inferior medullary velum. Histo-molecular analysis revealed a grade 2 ependymoma. The patient was discharged home neurologically intact.
The combined telovelar-posterolateral approach allowed to achieve a near total resection of a giant multicompartimental mass within the posterior fossa in a single surgical stage.

The head and neck region is a complex anatomical area with vulnerable nervous and vascular structures, auditory and visual organs and upper aero-digestive tract. Penetrating foreign bodies of head and neck region are not uncommon and pertain mostly to wood, metal and glass (Levine et al. in Am J Emerg Med 26:918-922, 2008). This case report describes an airborne high velocity foreign body blown off from a lawn mower penetrating the left side of the face, penetrating deep into nasopharynx and opposite parapharyngeal space through paranasal sinuses. A multidisciplinary team managed this case successfully, avoiding injuries to adjacent vital skull base structures.