Temporal evolution of programmed death-ligand 1 expression in patients with non-small cell lung cancer

Background/Aims@#Programmed death-ligand 1 (PD-L1) expression, a validated predictive biomarker for anti-PD-1/PD-L1 inhibitors, is reported to change over time. This poses challenges during clinical application in non-small cell lung cancer. @*Methods@#This study included patients with non-small cell lung cancer who underwent surgery or biopsy and evaluation of PD-L1 expression in tumor cells via immunohistochemistry more than twice. We set the threshold of PD-L1 positivity to 10% and categorized patients into four groups according to changes in PD-L1 expression. Clinicopathologic information was collected from medical records. Statistical analyses, including Fisher’s exact test and log-rank test, were performed. @*Results@#Of 109 patients, 38 (34.9%) and 45 (41.3%) had PD-L1 positivity in archival and recent samples, respectively. PD-L1 status was maintained in 78 (71.6%) patients, but changed in 31 (28.4%), with 19 (17.4%) from negative to positive. There were no significant differences in characteristics between patients who maintained PD-L1 negativity and whose PD-L1 status changed from negative to positive. Patients harboring PD-L1 positivity in either archival or recent samples achieved better responses (p = 0.129) and showed longer overall survival than those who maintained PD-L1 negativity when they received immune checkpoint inhibitors after platinum failure (median overall survival 14.4 months vs. 4.93 months; hazard ratio, 0.43; 95% confidence interval, 0.20 to 0.93). @*Conclusions@#PD-L1 status changed in about one-fourth of patients. PD-L1 positivity in either archival or recent samples was predictive of better responses to immune checkpoint inhibitors. Therefore, archival samples could be used for assessment of PD-L1 status. The need for new biopsies should be decided individually.

Temporal evolution of programmed death-ligand 1 expression in patients with non-small cell lung cancer

Background/Aims@#Programmed death-ligand 1 (PD-L1) expression, a validated predictive biomarker for anti-PD-1/PD-L1 inhibitors, is reported to change over time. This poses challenges during clinical application in non-small cell lung cancer. @*Methods@#This study included patients with non-small cell lung cancer who underwent surgery or biopsy and evaluation of PD-L1 expression in tumor cells via immunohistochemistry more than twice. We set the threshold of PD-L1 positivity to 10% and categorized patients into four groups according to changes in PD-L1 expression. Clinicopathologic information was collected from medical records. Statistical analyses, including Fisher’s exact test and log-rank test, were performed. @*Results@#Of 109 patients, 38 (34.9%) and 45 (41.3%) had PD-L1 positivity in archival and recent samples, respectively. PD-L1 status was maintained in 78 (71.6%) patients, but changed in 31 (28.4%), with 19 (17.4%) from negative to positive. There were no significant differences in characteristics between patients who maintained PD-L1 negativity and whose PD-L1 status changed from negative to positive. Patients harboring PD-L1 positivity in either archival or recent samples achieved better responses (p = 0.129) and showed longer overall survival than those who maintained PD-L1 negativity when they received immune checkpoint inhibitors after platinum failure (median overall survival 14.4 months vs. 4.93 months; hazard ratio, 0.43; 95% confidence interval, 0.20 to 0.93). @*Conclusions@#PD-L1 status changed in about one-fourth of patients. PD-L1 positivity in either archival or recent samples was predictive of better responses to immune checkpoint inhibitors. Therefore, archival samples could be used for assessment of PD-L1 status. The need for new biopsies should be decided individually.

The Treatment for Hallux Valgus with Scarf Osteotomy in Elderly Patients with Osteoporosis / 대한족부족관절학회지

PURPOSE: The aim of this study was to evaluate the radiological and clinical outcomes of scarf osteotomy for hallux valgus (HV) deformity in elderly patient with osteoporosis. MATERIALS AND METHODS: A total of 58 elderly patients (mean age, 72.6 years) underwent scarf osteotomy for HV deformity between 2008 and 2015. The mean follow-up period was 24.4 months. Of the 58 patients, 42 were diagnosed with osteoporosis and 16 were diagnosed as normal. The radiological and clinical outcomes were assessed preoperatively, postoperatively, and at final follow-up, including HV angle, intermetatarsal (IM) angle, American Orthopaedic Foot and Ankle Society (AOFAS) score, patient satisfaction, visual analogue scale (VAS), and complication. RESULTS: There was no significant difference in HV angle and IM angle between the osteoporosis group and normal bone mineral densitometry group at all time points, preoperative, postoperative, and final follow-up. Moreover, there was no statistically significant difference between the two groups with respect to the AOFAS score and VAS evaluations. In the osteoporosis group, the mean HV angle improved from 36.7° preoperatively to 11.3° at the time of final follow-up, and the mean IM angle improved from 13.2° to 5.7°. The mean AOFAS score improved from 52.6 preoperatively to 89.1 at the time of final follow-up. With respect to satisfaction, 83.4% of patients were very satisfied or satisfied. There were no serious complications, and all cases showed complete union at the osteotomy site. CONCLUSION: We believed that scarf osteotomy is a safe, effective procedure for the correction of elderly patients with osteoporosis.

Achromobacter xylosoxidans Infection Following Total Knee Arthroplasty / 대한정형외과학회잡지

Achromobacter xylosoxidans is an opportunistic organism, mainly causing infection in immune compromised hosts, such as patients on dialysis. However, review of the medical literature showed that few cases of A. xylosoxidans infections following total knee arthroplasty have been reported. This organism has not been reported in prosthetic joint infections of patients who are not immune compromised. Here, a case of periprosthetic infection with A. xylosoxidans following total knee arthroplasty in a man with no medical history of immune suppression is reported.

Comparative Study of Osteoporosis Treatment of Elderly Patients with Degenerative Osteoarthritis of the Knee Joints, according to the Korean Health Insurance Review & Assessment Service Criteria versus the FRAX(R) Criteria / 대한정형외과학회잡지

PURPOSE: To compare and evaluate any differences in the osteoporosis treatments of elderly patients with degenerative osteoarthritis of the knee joints, in accordance with the Korean Health Insurance Review & Assessment Service (HIRA) criteria versus the World Health Organization (WHO) fracture risk assessment tool (FRAX(R), http://www.shef.ac.uk/FRAX/) criteria, which is a fracture risk assessment tool developed by the WHO. MATERIALS AND METHODS: From June 2010 to March 2011, we investigated and screened the target populations of osteoporosis treatments among 65-year-old or older patients with degenerative osteoarthritis of the knee joints who scheduled to undergo elective total knee arthroplasty. They were classified in the treatment group only if they met either the HIRA criterion, defined as having a T score of or =20% or > or =3%, respectively. RESULTS: Of a total of 929 patients, the number of patients included in the treatment group as screened according to the HIRA or FRAX(R) criteria was 562 (60.5%) and 372 (40.0%), respectively. The number of patients who met both criteria was 339 (36.5%), and including 334 non-treated patients (36.0%), a total of 673 patients (72.4%) showed low diagnostic concordance (k=0.471). Of 319 patients diagnosing osteopenia, 33 (10.3%) patients were included in the treatment group according to the FRAX(R) criteria. CONCLUSION: A combination of the HIRA and FRAX(R) criteria is required to improve the current guidelines for osteoporosis treatment.

The Short-term Follow-up Results of Open Wedge High Tibial Osteotomy with Using an Aescula Open Wedge Plate and an Allogenic Bone Graft: The Minimum 1-Year Follow-up Results

BACKGROUND: This study examined the results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft as a surgical technique for the patients who suffer from osteoarthritis of the knee with a genu varum deformity. METHODS: From March 2007 to August 2007, 33 patients (37 cases) with osteoarthritis of the knee and a genu varum deformity underwent a high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft. The patients were followed up for more than 1 year. Before and after surgery, the correction angle of the genu varum was measured by the lower extremity scannogram and the posterior tibial slope, the joint space distance and the time to bone union were evaluated. The functional factors were evaluated using the Knee Society Score. RESULTS: The average knee score and function score improved from 52.19 +/- 11.82 to 92.49 +/- 5.10 and 52.84 +/- 6.23 to 89.05 +/- 5.53, respectively (p < 0.001). According to the lower extremity scannogram, the mean preoperative varus angle was -1.86 +/- 2.76degrees, and the average correction angle at the last follow-up was 10.93 +/- 2.50degrees (p < 0.001). The tibial posterior slope before surgery and at the last follow-up were 8.20 +/- 1.80degrees and 8.04 +/- 1.30degrees, respectively (p = 0.437). The joint space distance increased from 4.05 +/- 1.30 mm to 4.83 +/- 1.33 mm (p < 0.001). The average time to complete bone union was 12.69 +/- 1.5 weeks. CONCLUSIONS: An open wedge high tibial osteotomy using an Aescula open wedge plate and an allogeneic bone graft to treat osteoarthritis of the knee with a genu varum deformity showed good results for the precision of the correction angle, the time to bone union and the functional improvement.

Perioperative Changes in C-Reactive Protein Levels after Unilateral and Simultaneous Bilateral Total Knee Replacement / 대한정형외과학회잡지

PURPOSE: The objective of this study was to determine the patterns of C-reactive protein (CRP) changes during the postoperative period after total knee replacement (TKR), and to determine the CRP changes associated with infection after TKR. MATERIALS AND METHODS: A retrospective analysis of the pattern of CRP changes during the first 6 postoperative months was conducted on 2,315 patients who underwent unilateral or simultaneous bilateral TKR. This data was also compared with the pattern of CRP changes which occurred in 19 patients with a deep prosthesis infection who were not enrolled in the main study. RESULTS: The CRP levels peaked 3 days postoperatively, and then decreased to baseline levels at 15-28 days postoperatively. Within 14 days postoperatively, the CRP levels were significantly higher in the simultaneous bilateral TKA group than in the unilateral group (p<0.01). Thereafter, no significant difference in CRP levels existed between two groups. After the 8th postoperative day, a significant difference in CRP level existed between patients with and without deep prosthesis infections. CONCLUSION: CRP changes post-TKR provide an effective means of monitoring of infections. In cases of non-inflammatory arthritis in which the CRP levels are significantly difference after the 8th postoperative day or are elevated after the 4th postoperative week, an infection should be suspected.

The Influence of Tibial Positioning on the Diagnostic Accuracy of Combined Posterior Cruciate Ligament and Posterolateral Rotatory Instability of the Knee

BACKGROUND: To determine if tibial positioning affects the external rotation of the tibia in a dial test for posterolateral rotatory instability combined with posterior cruciate ligament (PCL) injuries. METHODS: Between April 2007 and October 2007, 16 patients with a PCL tear and posterolateral rotatory instability were diagnosed using a dial test. The thigh-foot angle was measured at both 30degrees and 90degrees of knee flexion with an external rotation stress applied to the tibia in 2 different positions (reduction and posterior subluxation). The measurements were performed twice by 2 orthopedic surgeons. RESULTS: In posterior subluxation, the mean side-to-side difference in the thigh-foot angle was 11.56 +/- 3.01degrees at 30degrees of knee flexion and 11.88 +/- 4.03degrees at 90degrees of knee flexion. In the sequential dial test performed with the tibia reduced, the mean side-to-side difference was 15.94 +/- 4.17degrees (p < 0.05) at 30degrees of knee flexion and 16.88 +/- 4.42degrees (p = 0.001) at 90degrees of knee flexion. The mean tibial external rotation was 5.31 +/- 2.86degrees and 6.87 +/- 3.59degrees higher in the reduced position than in the posterior subluxation at both 30degrees and 90degrees of knee flexion. CONCLUSIONS: In the dial test, reducing the tibia with an anterior force increases the ability of an examiner to detect posterolateral rotary instability of the knee combined with PCL injuries.

Comparative Study of ACL Double-bundle Reconstruction with and without Functional Knee Brace: Minimum 1-year Follow-up Results / 대한정형외과학회잡지

PURPOSE: To compare the clinical efficacy after an arthroscopic ACL double-bundle reconstruction with and without functional knee brace. MATERIALS AND METHODS: Between July 2004 and May 2006, fifty patients who underwent an ACL double-bundle reconstruction with and without a functional knee brace for more than a 1-year follow-up were evaluated. The patients were treated with brace (Group 1, 22 cases) or without (Group 2, 28 cases) a brace after surgrey. Stability was assessed by maximal manual testing with a KT-1000 arthrometer, anterior stress radiographs using the Telos device and a lateral pivot shift test. The clinical results were assessed by the OAK (Orthopadische Arbeitsgruppe Knie) score, IKDC (International Knee Documentation Committee) score, mid thigh circumference and the range of motion. RESULTS: More than one year after surgery, average of OAK score, IKDC score, lateral pivot shift test of the stability results and maximal manual testing with the KT-1000 arthrometer, stress radiographs with the Telos device, mid thigh circumference difference, range of motion of the clinical results were similar in both groups. CONCLUSION: An ACL double-bundle reconstruction produces similar stability and clinical results regardlness of whether or not a functional knee brace is used.

Heterotopic Bone Formation in Patient who Underwent a Posterior Cruciate Ligament Reconstruction using the Inlay Method and Posterolateral Corner Sling with a Tibia Tunnel: A Case Report / 대한정형외과학회잡지

We describe a case of posterolateral capsular heterotopic ossification requiring a surgical excision after a PCL (Posterior Cruciate Ligament) reconstruction using the modified inlay method and PLCS (posterolateral corner sling) with a tibia tunnel. A 21-year-old female patient had suffered a blunt proximal tibial direct trauma 6 months earlier. She did not experience limb ischemia or a pulse deficit before she visited our out patient clinic. She had not suffered any trauma in other sites, and showed a range of motion of 0 to 30degrees at 4 months after surgery. There was no specific finding on the X-ray images. Arthroscopic adhesiolysis was performed and her range of motion increased to 0 to 120degrees. However, 6 months after the initial operation, she showed ankylosis and heterotopic ossification at the posterior aspect, which was surgically removed at 12 months postoperatively. After the second surgery, there was no recurrence and she showed a 0 to 140degrees range of motion at postoperative 42 months.

Posterior Vertebral Column Resection for Severe Spinal Deformities / 대한정형외과학회잡지

PURPOSE: To report a technique of vertebral column resection using a single posterior approach and its results in the treatment of severe spinal deformities. MATERIALS AND METHODS: Seventy spinal deformity patients treated by posterior vertebral column resection (PVCR) were retrospectively reviewed with minimum follow up of 2 years (2-3.3 years). There were 34 males and 36 females with a mean age of 27.4 years. Etiologic diagnoses were; adult scoliosis in 7, congenital kyphoscoliosis in 38, and post-infectious kyphosis in 25. The surgery consisted of temporary stabilization of the vertebral column with segmental pedicle screw fixation, resection of the vertebral column at the apex of the deformity via the posterior route followed by gradual deformity correction and fusion. Radiological and clinical data were reviewed for deformity correction and clinical results. RESULTS: The total number of resected vertebrae were 143: 76 thoracic and 67 lumbar. Mean operation time was 4 hours 31 minutes with an average blood loss of 2, 333 mL. The deformity correction was 62.9% in the coronal plane and 45.2 degrees in the sagittal plane. Complications were encountered in 24 patients: 2 complete cord injuries in severe adult scoliosis and a single thoracic kyphosis patient who had significant preoperative cord compromise, 6 hematomas, 4 root injuries (all incomplete), 5 fixation failures, 2 infections and 5 hemopneumothoraxes. CONCLUSION: PVCR is an effective alternative for severe fixed spinal deformities. However, extreme caution must be taken in patients with preoperative cord compromise who have a high risk of neurological complications.