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To provide a systematic overview of clinical and radiographic outcomes in patients who underwent surgical treatment of a painful avulsion fragment of the distal fibula also known as posttraumatic os subfibulare.

A systematic literature search across two major sources (PubMed and Scopus) was performed. Twenty-seven studies were included and analyzed using the modified Coleman score to assess the methodologic quality.

The surgical treatment of symptomatic os subfibulare, with or without concomitant ankle instability, generally results in substantial improvement in clinical and radiographic outcomes with relative low complication rates. Clinical outcome measures may not be affected by the presence of ankle instability or by the fragment size. The methodological quality of analyzed studies was satisfactory.

Posttraumatic os subfibulare may result in chronic pain and ankle instability. If surgery is indicated, ankle instability should be concomitantly addressed when present. Based on available literature, satisfactory postoperative outcomes can be reliably expected following surgical treatment.

Systematic Review of Level III and Level IV Studies, Level IV.

Systematic Review of Level III and Level IV Studies, Level IV.

Different types of drug-eluting beads have been proposed for hepatocellular carcinoma (HCC) treatment, but long-term results are not well known. We report safety, efficacy and long-term overall survival of HCC patients not amenable of curative therapies treated with transcatheter arterial chemoembolization (TACE) using drug-eluting beads sized 70-150micron.

This single-center retrospective study included 125 patients with Barcelona Clinic Liver Cancer stage A (80), B (45) and compensated cirrhosis. TACE was executed injecting drug-elutings microparticles loaded with 75mg of Doxorubicine and was repeated in patients with partial response or stable disease after one month. Adverse events, response according to modified Response Evaluation Criteria in Solid Tumors and overall survival were assessed.

Chemoembolization with 70-150micron beads revealed an objective response rate of 88% according to mRECIST criteria and complete response was 60%. After a median follow-up of 53.3months, overall survival was 36.6months. Data were censored at the date of liver transplantation in 35 patients. 33 on 125 patients (26,4%) experienced at least one adverse event. We recorded a total of 102 adverse events and 18 were of a high grade (G3-G4). 30day mortality was 0%.

Chemoembolization with very small particles (70-150µm) is an effective and safe treatment in unresectable HCC both as a primary therapy or as bridge to transplantation.

Chemoembolization with very small particles (70-150 µm) is an effective and safe treatment in unresectable HCC both as a primary therapy or as bridge to transplantation.

To assess the feasibility and outcome of ultrasound-guided cryoablation in patients with a sensitized stump neuroma after limb amputation.

Seven patients (3 females, 4 males; mean age 42years) were included in this retrospective study. Ultrasound-guided cryoablation of a previously identified painful stump neuroma was performed. Pain was assessed on the visual analogue scale (VAS) and compared before and after cryoablation (Wilcoxon Test). The degree of pain alleviation was correlated with patient age, duration of pain before ablation and time interval between amputation and ablation (Spearman correlation). A p-value less than 0.05 was deemed statistically significant.

Nine cryoablations were performed for 8 neuromas. Technical success was 100%, there were no major complications. Mean follow-up was 27months. There was a statistically significant decrease of pain from mean 8.3 / 10 (baseline) to 4 /10 (on day one), 2.1 / 10 (at one week) and 3 / 10 (at last follow-up) (p < 0.05). Patient satisfaction with cryoablation treatment was very high (median score 70 / 100).

In our small population observational study, ultrasound-guided cryoablation of a sensitized stump neuroma was effective and safe for pain alleviation with very good long-term results.

Level 2, Observational study with dramatic effect.

Level 2, Observational study with dramatic effect.

This study aimed to evaluate the impact of isotretinoin therapy on the nasal skin thickness and elasticity with regard to implications for rhinoplasty METHODS A total of 40 acne vulgaris patients (mean±SD age 20.9 ± 3.0 years, 65.0% were females) initiating oral isotretinoin treatment (0.25 mg/kg/day, n = 16 or 0.5 mg/kg/day, n = 24) were included in this prospective 4-month isotretinoin follow-up study. Ultrasonography assessments regarding nasal skin thickness (dermis and soft tissue) and elastography were repeated at second and fourth months of treatment.

No significant difference was noted between isotretinoin dose groups in terms of second month and fourth month nasal skin thickness (dermis and soft tissue) values measured at any region. Each dose revealed significant decrease in dermis and soft tissue thickness from baseline at any region (p ranged  < 0.001 to  < 0.001), while only fourth month values at nasal tip and second month values at rhinion for dermis and only fourth month values at rh description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Body dysmorphic disorder (BDD) and other psychological problems are more common in cosmetic surgery applicants.

The aim of this study was to investigate the frequency of the symptoms of BDD and narcissistic personality disorder in rhinoplasty candidates.

This descriptive cross-sectional study was performed on rhinoplasty applicants. All subjects were evaluated by BDD and narcissistic personality questionnaires (NPI-16).

A total of 380 patients were studied. Our findings showed that the prevalence of mild, moderate, and severe BDD symptoms was 31.6%, 43.4% and 25%, respectively. The mean BDD scores were not significantly different in variables such as gender, age, marital status, history of cosmetic surgery, education, place of residence, and income. 29.5% of the subjects had symptoms of narcissism. There was no significant relationship between the symptoms of narcissism and variables such as gender, age, marital status, history of cosmetic surgery, place of residence, and income. Higher education was associated with higher rates of narcissistic personality disorder (p-value = 0.021).

According to the results of the study, there was no statistically significant relationship between BDD score and demographic parameters. Also, association between narcissistic personality disorder and demographic characteristics was not significant except for education.

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 .

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 .

This study valued MR delayed enhancement pattern in predicting postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma (IMCC).

From 2011 to 2015, 231 patients of IMCC underwent DCE-MRI preoperatively. Enhancement patterns and MRI characteristics were evaluated. Recurrence and mortality data were compared among IMCCs with different enhancement patterns. Prognostic factor analysis was performed using preoperative and postoperative clinical-pathologic factors, as well as imaging findings.

Fifty-six (24.2%), 142 (61.5%) and 33 (14.3%) tumors showed hypo, peripheral rim and diffuse hyper enhancement in AP. Fifty-six (24.2%), 81 (35.1%) and 94 (40.7%) tumors showed hypo, heterogeneous and uniform enhancement in DP. Patients with arterial diffuse hyper enhancement or delayed uniform enhancement IMCCs had lower preoperative CA19-9 levels, smaller tumor sizes and minor operations than the rest patients (p < 0.05) and they were less associated with lymph nodes metastasis, vascular invasion, necrosis or poor tumor differentiation (p < 0.05), therefore with higher overall and disease-free survival rates (p < 0.05). The combination of AP and DP increased the detection rate of patients with good prognosis in the arterial rim enhancement group. Multivariate analysis revealed the delayed enhancement pattern (hypo HR = 6.304/10.028 for DFS/OS; heterogenous HR = 4.579/4.972 for DFS/OS), multitude of lesions (HR = 1.6/1.5 for DFS/OS) and tumor sizes (HR = 1.6 for DFS) were independent prognostic factors.

The uniform enhancement pattern in delayed MRI was an independent optimal prognostic factor for IMCCs and increased the detection rate of patients with good prognosis compared to the arterial diffuse hyper enhancement pattern.

The uniform enhancement pattern in delayed MRI was an independent optimal prognostic factor for IMCCs and increased the detection rate of patients with good prognosis compared to the arterial diffuse hyper enhancement pattern.

To compare the efficacy and safety of percutaneous ethanol injection (PEI) combined with transarterial chemoembolization (TACE + PEI) vs. TACE alone for the treatment of patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT).

A total of 130 HCC patients with PVTT treated from May 2014 to August 2018 were retrospectively evaluated. Among them, 33 patients received TACE + PEI and 97 patients received TACE alone. Doxorubicin manufacturer PVTT was classified according to the Japanese Society of Hepatology; 97 patients had VP3 PVTT. Propensity score matching (PSM) was used to reduce selection bias.

Before PSM, the median overall survival (mOS) was 11months (95% CI 7.8-14.2) in the TACE + PEI group and 6months (95% CI 5.1-6.9) in the TACE group (p < 0.001), and the median progression-free survival (mPFS) was 5months (95% CI 3.7-6.3) in the TACE + PEI group and 2.5months (95% CI 2.1-2.9) in the TACE group (p < 0.001). Similar results were seen after PSM. Subgroup analysis showed that in patients with tumors > 5cm in diameter and the VP3 subgroup, TACE + PEI brought a significant survival advantage over TACE alone before and after PSM. In the adverse event analysis, severe abdominal pain and bleeding after operation were seen in more patients in the TACE + PEI group than in the TACE group before PSM (P < 0.05).

For HCC patients with PVTT (especially those with tumor diameters > 5cm and grade VP3), TACE combined with PEI for HCC patients with PVTT is safe and may provide better survival outcomes.

 5 cm and grade VP3), TACE combined with PEI for HCC patients with PVTT is safe and may provide better survival outcomes.

Psychiatric comorbidity is defined as the joint occurrence of two or more mental or substance use disorders. Widespread psychiatric comorbidity has been reported in treatment and population-based studies. The aim of this study was to measure the extent and impact of psychiatric comorbidity in a cohort of the Baltimore Epidemiologic Catchment Area study.

We examined the comorbidity burden of 16 mental disorders in a cohort of 847 participants using both established and novel analytical approaches The Comorbidity to Diagnosis Inflation Ratio (CDIR), is a statistical instrument that quantifies impact of pairwise comorbid associations, both on the whole sample, as well as on each specific disorder.

Most anxiety disorders had substantial co-occurrence with each other, as well as with Major Depressive Disorder (MDD). In addition, mood disorders had a high degree of comorbidity with Alcohol Dependence (AD). The CDIR for the whole sample was 1.32, indicating a ratio of 132 comorbidities per 100 diagnoses. The conditions with high sample prevalence were relatively less comorbid than the low prevalence conditions.