Quantification of interstitial cells of Cajal and fibrosis during gastric per-oral endoscopic myotomy and its association with clinical outcomes.

Background and study aims Alterations to interstitial cells of Cajal (ICC) and collagen fibrosis have been implicated in the pathogenesis of gastroparesis. We aimed to evaluate the feasibility and safety of pyloric muscle sampling during gastric peroral endoscopic myotomy (G-POEM) and the association between pyloric ICC density and degree of fibrosis with clinical outcomes. Patients and methods This was a single-center prospective study of gastroparetic patients who underwent G-POEM and intraprocedural pyloric muscle biopsies between January 2022 and April 2023. ICC count was estimated using CD117 stain and trichome for collagen fibrosis. Clinical response to G-POEM was defined as an improvement of ≥ 1 point on the Gastroparesis Cardinal Symptom Index. Results Fifty-six patients (median age 60 years, 71.4% women) underwent G-POEM (100% technical success; 71.4% clinical response). ICC depletion (< 10/high-power field) and fibrosis were encountered in 70.4% and 75% of the cases, respectively. There was no difference in mean ICC count between G-POEM responders vs. non-responders (7±3.6 vs. 7.7±3.3; P = 0.9). There was no association between ICC density or degree of fibrosis with the etiology of gastroparesis, duration of symptoms, gastric emptying rate, or pyloric impedance planimetry. Patients who did not respond to G-POEM had a significantly higher degree of moderate/severe fibrosis when compared with those who responded (81.3% vs. 25%; P = 0.0002). Conclusions Pyloric muscle biopsies during G-POEM was feasible and safe. ICC depletion and pyloric muscle fibrosis are common in gastroparetic patients. The degree of fibrosis may be related to pyloric dysfunction and clinical response to G-POEM. Additional studies are needed to confirm these results.

Rapid recurrence of stage IIB non-gestational ovarian choriocarcinoma with minor yolk sac tumor: A rare case report and literature review.

Non-gestational ovarian choriocarcinoma (NGOC) is a rare phenomenon seldom reported in the literature. Patients often present with abdominopelvic pain, and sometimes a palpable adnexal mass. Surgical excision is paramount in treating this malignancy; however, fertility-preserving care is a debated topic among gynecologic oncologists. Most patients reported in the literature are nulliparous women of child-bearing age. It is important to consider fertility preservation whilst balancing oncologic outcomes. We present a case of an 18-year-old nulliparous female with stage IIB NGOC that had disease progression in the lungs and pelvis shortly after undergoing fertility-preserving surgery. She required emergent completion surgery and received etoposide (E), methotrexate (M), actinomycin-D (A), cyclophosphamide (C) and vincristine (O) (EMA-CO) with complete response. She remains disease-free after 21-months.

Compositional induced structural phase transitions in (1 - x)(K0.5Na0.5)NbO3-x(Ba0.5Sr0.5)TiO3 ferroelectric solid solutions.

Ferroelectric materials exhibiting switchable and spontaneous polarization have strong potential to be utilized in various novel electronic devices. Solid solutions of different perovskite structures induce the coexistence of various phases and enhance the physical functionalities around the phase coexistence region. The construction of phase diagrams is important as they describe the material properties, which are linked to the underpinning physics determining the system. Here we present the phase diagram of (K0.5Na0.5NbO3)-(Ba0.5Sr0.5TiO3) (KNN-BST) system as a function of composition and their associated physical properties. Lead-free (1 - x)KNN-xBST (0 ≤ x ≤ 0.3) solid solution ceramics were synthesized by conventional solid-state reaction technique. The X-ray diffraction and Raman spectroscopic studies indicate composition-dependent structural phase transitions from an orthorhombic phase for x = 0 to orthorhombic + tetragonal dual-phase (for 0.025 ≤ x ≤ 0.15), then a tetragonal + cubic dual-phase (x = 0.2) and finally a cubic single phase for x ≥ 0.25 at room temperature (RT). Among these, the orthorhombic + tetragonal dual-phase system shows an enhanced value of the dielectric constant at room temperature. The phase transition temperatures, orthorhombic to tetragonal (TO-T) and tetragonal to cubic (TC), decrease with the increase in BST concentrations. The ferroelectric studies show a decrease of both 2Pr and EC values with a rise in BST concentration and x = 0.025 showed a maximum piezoelectric coefficient.

Gallbladder Cancer or Diffuse Xanthogranulomatous Cholecystitis: A Case of Management Dilemma During Elective Cholecystectomy With Unexpected Severe Mass-Like Pericholecystic Fibrosis and Inflammation.

A 52-year-old man was scheduled to undergo an elective laparoscopic cholecystectomy for an increasingly symptomatic cholelithiasis. The pre-operative diagnosis was established clinically and confirmed with ultrasonography (US), showing gallstones and thickened gallbladder wall. Intraoperatively, extensive dense adhesions of the omentum to the entire subdiaphragmatic surface of the liver and the diaphragm were encountered. The adhesions of the omentum and colon were completely obscuring the Morrison's space with cartilage-like consistency at the supposed anatomical projection of the gallbladder fundus. Due to these unexpected pathological findings and uncertain disease biology, a decision was made to abort and re-schedule the surgery after obtained tissue biopsy results, magnetic resonance cholangiopancreatography (MRCP), and tumor markers carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA), and alpha fetoprotein (AFP) were available. CA 19-9 was found elevated 10-fold, while AFP and CEA levels were within normal limits. A follow-up cholecystectomy was performed, and final pathology revealed diffuse xanthogranulomatous cholecystitis (XC) and extensive inflammatory changes, adhesions, and fibrosis and no malignancy. The patient tolerated the procedure well and was discharged home on day two after surgery. His follow-up examination was unremarkable. Distinguishing between XC and gallbladder carcinoma is important to appropriately guide management and treatment.

Lead-Free Relaxor Ferroelectric Ceramics with Ultrahigh Energy Storage Densities via Polymorphic Polar Nanoregions Design.

One of the long-standing challenges of current lead-free energy storage ceramics for capacitors is how to improve their comprehensive energy storage properties effectively, that is, to achieve a synergistic improvement in the breakdown strength (Eb ) and the difference between maximum polarization (Pmax ) and remnant polarization (Pr ), making them comparable to those of lead-based capacitor materials. Here, a polymorphic polar nanoregions (PNRs) structural design by first introducing 0.06 mol BaTiO3 into Bi0.5 Na0.5 TiO3 is proposed to construct the morphotropic phase boundary with coexisting structures of micrometer-size domains and polymorphic nanodomains, enhance the electric field-induced polarization response (increase Pmax ). Then Sr(Al0.5 Ta0.5 )O3 (SAT)-doped 0.94 Bi0.5 Na0.5 TiO3 -0.06BaTiO3 (BNBT) energy storage ceramics with polymorphic PNRs structures are synthesized following the guidance of phase-field simulation and rational composition design (decrease Pr ). Finally, a large recoverable energy density (Wrec ) of 8.33 J cm-3 and a high energy efficiency (η) of 90.8% under 555 kV cm-1 are obtained in the 0.85BNBT-0.15SAT ceramic prepared by repeated rolling process method (enhance Eb ), superior to most practical lead-free competitors increased consideration of the stability of temperature (a variation <±6.2%) and frequency (Wrec > 5.0  cm-3 , η > 90%) at 400 kV cm-1 . This strategy provides a new conception for the design of other-based multifunctional energy storage dielectrics.

Elucidation of Structural, Morphological, Electrical Parameters, and Anti-Bacterial Activity of Polyaniline-Nanocomposite: New Paradigm of Controlling Bacterial Activity.

In this communication, we purpose an alternative electrical method to determine the anti-bacterial activity of compounds. Polyaniline/magnetite (Fe3O4/PANI) and polyaniline/hydrochloric acid (HCl/PANI) nanocomposites have been prepared. We have tested the anti-bacterial activity of Fe3O4/PANI and HCl/PANI nanocomposites by Agarwell Diffusion Assay and Bacterial Inhibition Assay method. The electrical characteristics of the prepared composites have been measured. The doping of 12% of Fe3O4 in PANI caused a substantial increase in anti-bacterial activity. The observed bacterial inhibition is in agreement with optimized values of resistivity, loss factor, quality factor, and spontaneous magnetization. Sample 2 associated with 12% Fe3O4-PANI composites has a high resistivity of 1.70×106Ω .m among all prepared composites. The magnetic character and insulating nature of Fe3O4 influenced the investigated parameters. The morphological variation of prepared composites is also consistent with electrical parameters. The alleviated energy zone formed by the magnetic behavior of Fe3O4 and interfacial polarization of PANI mitigates the polarization/field of charge carriers of bacteria. These effects altogether diminish the energy of bacterial zone revealed in the experiment. The tuning of electrical parameters provides an alternative to control bacterial growth in various compounds. The proposed method of electrical characterization for the detection of the anti-bacterial activity of the compounds can be very useful in terms of time and cost in contrast to the lab tests performed in biological labs. After implementing an electrical parameter standard equivalent to anti-bacterial activity, real-time detection can be performed by electrical parameters in the fields outside without any hassle, which otherwise is not possible for biological labs.

Ganglioneuroblastoma arising in a Mature Cystic Teratoma of Ovary: Report and Literature review of an uncommon neoplasm.

•Somatic neoplasms in Mature Cystic Teratoma are uncommon; Ganglioneuroblastoma is rare, this is 2nd reported case.•Due to rarity, it can pose a diagnostic challenge for Pathologists, and management and staging conundrum for Gynecologists.•Morphological differentials include immature teratoma, glial neoplasms arising in teratoma, and carcinoid.

Rhabdomyoma of the Larynx: A Case Report and Literature Review of a Rare Tumor in an Uncommon Location.

OBJECTIVES: Laryngeal rhabdomyomas are extremely rare, benign striated muscle tumors that have been documented only ∼50 times in the literature. They can be subdivided into two types: fetal and adult types, with the adult type being more common. Common presenting symptoms include hoarseness or progressive dysphagia. Diagnosis is made via immunohistochemical and microscopic analysis. Management is typically surgical, most commonly endoscopic, or open resection. METHODS: A comprehensive literature review was conducted with PubMed's MEDLINE index using the following search string: "rhabdomyoma" AND ("larynx" OR "laryngeal" OR "head" OR "neck"). After exclusion criteria were applied, a total of 58 cases were included. The purpose of our literature review was to elucidate information about age/gender, location, size, chief complaint and duration, treatment, and recurrence from each of the 58 cases to identify trends that could guide future diagnosis and management. RESULTS: The average age at diagnosis of laryngeal rhabdomyoma was 52.6 years with a 2.22:1 male predominance. Hoarseness and/or dysphonia was the most common chief complaint (42/58 cases, 72%), followed by dysphagia (12/58 cases, 21%). Common treatment options included endoscopic excision (18/48 cases, 37.5%) or open surgical resection (10/48 cases, 21%). Tumor recurrence was reported in 5/40 cases (14%), most likely due to incomplete removal of the tumor. CONCLUSIONS: Although laryngeal rhabdomyomas are rare, they should be considered in the differential diagnosis for patients with a submucosal laryngeal mass. Curative treatment is surgical via endoscopic resection. It is the preferred technique because of decreased morbidity compared to open resection. However, endoscopic resection was shown to have both higher rates of recurrence and shorter time to recurrence compared to open resection, necessitating frequent postoperative surveillance.

A real time face mask detection system using convolutional neural network.

In current times, after the rapid expansion and spread of the COVID-19 outbreak globally, people have experienced severe disruption to their daily lives. One idea to manage the outbreak is to enforce people wear a face mask in public places. Therefore, automated and efficient face detection methods are essential for such enforcement. In this paper, a face mask detection model for static and real time videos has been presented which classifies the images as "with mask" and "without mask". The model is trained and evaluated using the Kaggle data-set. The gathered data-set comprises approximately about 4,000 pictures and attained a performance accuracy rate of 98%. The proposed model is computationally efficient and precise as compared to DenseNet-121, MobileNet-V2, VGG-19, and Inception-V3. This work can be utilized as a digitized scanning tool in schools, hospitals, banks, and airports, and many other public or commercial locations.

Cyclops lesion - The entity causing loss of knee extension after ACL reconstruction surgery: A case report.

Cyclops is a fibrous nodule on the tibial side of the knee and it is one of the common complications that arises after anterior cruciate ligament (ACL) reconstruction surgery that causes loss of knee extension. In this literature, we have discussed about a young gentleman who presented with unresolved swelling and inability to extend knee joint fully 1 year after ACL reconstruction surgery. Cyclops lesion was identified by clinical examination and magnetic resonance imaging (MRI). An arthroscopic excision of the cyclops lesion was successfully done on this patient which resulted in a resolution of swelling and progressive improvement of knee extension.

Comparing Needles and Methods of Endoscopic Ultrasound-Guided Fine-Needle Biopsy to Optimize Specimen Quality and Diagnostic Accuracy for Patients With Pancreatic Masses in a Randomized Trial.

BACKGROUND & AIMS: Given the lack of procedure standardization, findings vary from analyses of pancreatic tissues collected by endoscopic ultrasound-guided fine-needle biopsy. It is not clear which needle and technique yield the best specimen for analysis. We compared the specimen quality and accuracy of diagnoses made from samples collected by fine-needle biopsy needles using different collection techniques. METHODS: Patients found to have pancreatic masses during imaging (n = 129) were assigned randomly to groups from whom pancreatic tissue samples were collected by reverse-bevel, Menghini-tip, franseen, or fork-tip needles. A second randomization determined the technical sequence of biopsies in each patient (suction, no suction, and stylet retraction). Two independent pathologists, blinded to the type of needle and sampling technique, analyzed all the samples. Final diagnoses of malignancy were made based on surgical resection, death from cancer progression, or findings from radiology or clinical follow-up evaluations (reference standard). The primary objective was to compare the cellularity of the samples collected, defined as the proportion of core tissue in the biopsy sample. Secondary objectives were to compare the accuracy of diagnoses made from biopsy samples and identify factors associated with high cellularity. RESULTS: One-hundred and nine patients had a final diagnosis of malignancy (84.5%) and 20 patients had benign disease (15.5%). Samples collected by fork-tip or franseen needles had significantly higher cellularity than samples collected by reverse-bevels or Menghini-tip needles (P < .001). Neoplasias were identified with greater than 90% accuracy using samples collected by fork-tip or franseen needles (P < .001 compared with other needles). On multivariable regression analysis, use of franseen needles (odds ratio [OR], 4.42; 95% CI, 2.58-7.58; P < .001) or fork-tip needles (OR, 3.86; 95% CI, 2.24-6.64; P < .001), stylet retraction (OR, 2.13; 95% CI, 1.21-3.72; P = .008), no suction (OR, 2.74; 95% CI, 1.57-4.80; P < .001), and pancreatic mass larger than 3 cm (OR, 1.92; 95% CI, 1.21-3.05; P = .005) were associated with high cellularity of the sample. CONCLUSIONS: In patients with suspected pancreatic cancer, samples with the highest degree of cellularity in a single biopsy, resulting in a diagnostic accuracy of 90% of higher, were collected by fine-needle biopsy using the franseen or fork-tip needle. Clinicaltrials.gov no: NCT04085055.

The Effect of Heat Treatment on the Microstructure and Mechanical Properties of 2D Nanostructured Au/NiFe System.

Nanostructured NiFe film was obtained on silicon with a thin gold sublayer via pulsed electrodeposition and annealed at a temperature from 100 to 400 °C in order to study the effect of heat treatment on the surface microstructure and mechanical properties. High-resolution atomic force microscopy made it possible to trace stepwise evolving microstructure under the influence of heat treatment. It was found that NiFe film grains undergo coalescence twice-at ~100 and ~300 °C-in the process of a gradual increase in grain size. The mechanical properties of the Au/NiFe nanostructured system have been investigated by nanoindentation at two various indentation depths, 10 and 50 nm. The results showed the opposite effect of heat treatment on the mechanical properties in the near-surface layer and in the material volume. Surface homogenization in combination with oxidation activation leads to abnormal strengthening and hardening-up of the near-surface layer. At the same time, a nonlinear decrease in hardness and Young's modulus with increasing temperature of heat treatment characterizes the internal volume of nanostructured NiFe. An explanation of this phenomenon was found in the complex effect of changing the ratio of grain volume/grain boundaries and increasing the concentration of thermally activated diffuse gold atoms from the sublayer to the NiFe film.

An ultra-broadband terahertz metamaterial coherent absorber using multilayer electric ring resonator structures based on anti-reflection coating.

We propose a method for achieving THz ultra-broadband coherent absorption using the anti-reflection theory of metamaterials. The metamaterial absorber consists of a periodic array of electric ring resonators with a multilayered structure which form the desired refractive index dispersion and provide continuous anti-reflection over a wide frequency range. The destructive interference mechanism and resonance absorption of the absorber are determined by simulation analysis and numerical simulation. Simulation results show that the absorption bandwidth is almost 8.02 THz (absorption rate >90%) over the entire terahertz band (0.1 THz-10 THz). This design provides an effective and viable method for constructing broadband absorbers for stealth technology and the construction of enhanced transmittance devices.

Investigation of AC-Measurements of Epoxy/Ferrite Composites.

A pure ferrite and epoxy samples as well as the epoxy/ferrite composites with different 20 wt.%, 30 wt.%, 40 wt.%, and 50 wt.% weight ferrite contents have been prepared by the chemical co-precipitation method. AC-conductivity and dielectric properties such as the dielectric constant and dielectric loss of the prepared samples have been studied. The obtained results showed that the samples had a semiconductor behavior. The dielectric constant of the composites has been calculated theoretically using several models. For the composite sample that contains 20 wt.% of ferrites, these models give satisfactory compliance, while for the composite samples with a higher percentage of nanofillers, more than 30 wt.% theoretical results do not coincide with experimental data. The investigated polymer has very low conductivity, so this type of polymer can be useful for high-frequency applications, which can reduce the losses caused by eddy current. Thus, the prepared samples are promising materials for practical use as elements of microwave devices.

Robotic sentinel lymph node (SLN) mapping in endometrial cancer: SLN symmetry and implications of mapping failure.

PURPOSE: To establish the bilateral pelvic concordance rate of the sentinel lymph node (SLN) and determine the likelihood of lymph node metastasis in cases of mapping failure. METHODS: A database analysis was performed on 414 patients with clinical stage I endometrial cancer who underwent SLN mapping followed by robotic hysterectomy and completion pelvic (n=414, 100%) and aortic (n=186, 44.9%) lymphadenectomy from March 2011 to August 2016. Stage, histology, SLN sites, and surgico-pathologic findings were analyzed. The bilateral concordance rate of SLN location, successful unilateral and bilateral mapping rates, false negative rate, and non-SLN metastasis associated with mapping failure were calculated. RESULTS: Histologies included 354 (85.5%) endometrioid, 39 (9.4%) serous, 16 (3.9%) carcinosarcoma, 4 (1.0%) clear cell, and 1 (0.2%) undifferentiated. Final stages included 262 (63.3%) IA, 36 (8.7%) IB, 15 (3.6%) II, 6 (1.4%) IIIA, 68 (16.4%) IIIC1, and 27 (6.5%) IIIC2. Bilateral SLN mapping was successful in 355 (85.7%) patients, and 266 (74.9%) demonstrated mapping to the symmetrical lymphatic group contralaterally. The mapping failure rate was 13.5% (56/414) unilaterally and 0.7% (3/414) bilaterally. SLN locations were external iliac (69.1%), obturator (25.1%), internal iliac (2.2%), common iliac (1.9%), pre-sacral (0.9%), aortic (0.4%), parametrial (0.3%), and para-rectal (0.1%). Lymph node metastases were identified in 95 (22.9%) pelvic and 27 (6.5%) aortic nodes. 10 (16.9%) cases with mapping failure had lymph node metastasis on completion lymphadenectomy, similar to the proportion of SLNs with metastases (p=0.35). However, macro-metastases were more common in mapping failure completion lymphadenectomies than in the positive SLNs (80% vs 22.3%, p<0.001). CONCLUSION: The contralateral SLN location concordance rate was 75%. Most SLNs were along the medial external iliac or obturator locations. The rate of positive lymph nodes associated with SLN mapping failure was 16.9%, similar to the overall node-positive rate. The detection of pelvic node metastasis with SLN mapping failure was largely populated with macro-metastases and confirms the necessity of completion lymphadenectomy with mapping failure.

The comparative evaluation of depth of cure of bulk-fill composites - An in vitro study.

INTRODUCTION: Resin-based composites (RBCs), as restorative dental materials, have given a new dimension to conservative and esthetic dentistry. The objective of the present study is to evaluate and compare the depth of cure of RBC's for posterior use: Sculptable bulk-fill composite - Tetric N-Ceram bulk fill (TNCBF), Flowable bulk-fill composites-TetricEvoflow bulk fill (TEFBF), Surefil SDR bulk fill (SDRBF), Dual cure bulk fill-Fill-Up (FDCBF) with conventional RBC-Esthet-X flow (EXF) and Filtex Z250 (FZ). MATERIALS AND METHODS: A standardized polyacrylic mold was bulk filled with each of the six composites and light-cured for 20 s, followed by 24 h storage in water. The surface hardness was measured on the top and the bottom by recording Vickers hardness number by Vickers hardness indenter. RESULTS: The mean bottom surface hardness value (HV) of SDR and TEFBF exceeded 80% of the top surface HV (HV-80%). Low viscosity bulk-fill composites (SDR and Tetric Evoflow) were properly cured in 4-mm increments. The TNCBF, high-viscosity composite, and Fill-Up, dual-cure bulk fill were not sufficiently cured in 4-mm increments. CONCLUSION: With increase in incremental thickness, HV decreased for the conventional resin composite but generally remained constant for the bulk-fill resin composites.

Retention of pit and fissure sealant versus flowable composite: An in vivo one-year comparative evaluation.

INTRODUCTION: Pits and fissures are extremely vulnerable to the development of caries. Resin-based materials for sealing pits and fissures (pit and fissure sealants and flowable composites) are helpful in caries control by physical barrier formation, which prevents metabolic exchange between fissure microorganisms and oral environment. Retention is one of the most important prerequisites for pit and fissure sealants. Debris and pellicle might not be removed by conventional prophylaxis and etching; therefore, air abrasion (AB) for fissure preparation has been advocated for sealant retention. This in vivo study was aimed to compare the retention of resin-based pit and fissure sealant to flowable resin composition occlusal pits and fissures of all first permanent molars with and without air-abrasion over a 12-month follow-up. MATERIALS AND METHODS: A randomized controlled clinical trial was done after obtaining ethical committee approval and informed and written consent. Thirty children with the age of 6-9 years, with all four caries-free first permanent molars without any hypoplasia/fracture but with pits and fissures prone to caries were included in this study. The four first molars were divided into the following four groups: Group A (tooth 16; sealant + AB), B (tooth 46; composite + AB), C (tooth 36; sealant), and D (tooth 26; composite). Assessments were made at 3, 6, 9, and 12 months for partial or total loss of sealant and caries according to Modified Simonsen's Criteria. RESULTS AND CONCLUSIONS: Flowable composite was relatively better retained than sealant at 12 months' follow-up although results were statistically insignificant. AB followed by acid etching brought superior retention than acid etching. Mandibular teeth have shown relatively superior retention. Future studies should aim at investigating better techniques and materials for sealing pit and fissures.

Endosalpingiosis of the Gallbladder: A Unique Complication of Ruptured Ectopic Pregnancy.

A 60-year-old woman with a history of a ruptured ectopic pregnancy and subsequent salpingo-oophorectomy presented with clinical signs. Pre-operative imaging and intra-operative observations were highly suggestive of acute on chronic cholecystitis. A laparoscopic cholecystectomy was performed. In addition to confirming calculous cholecystitis, final pathology revealed endosalpingiosis on the serosal surface of the gallbladder. Endosalpingiosis is a rare, benign presence of glands lined by tubal-like epithelium, and the few case reports describe it on the surface of the female reproductive organs or seeded on the pelvic peritoneum. We hypothesize that, in this unique case, the endosalpingiosis is due to patient's ruptured ectopic pregnancy, which allowed tubal epithelial cells to spread to the gallbladder. The only documented cases of endosalpingiosis outside the pelvic and lower abdominal organs have been congenital choristomas. To our knowledge, this is the first documented case of acquired endosalpingiosis of the gallbladder.

Management of valgus knee with irreducible patellar dislocation and MCL rupture: A case series.

INTRODUCTION: The high rate of recurrence in patellar dislocation treatment, requires a more comprehensive action, this is due to causes not only single but often multifactorial, including problems with static stability, dynamic stability or both. PRESENTATION OF CASE: 1st case: A-39-years-old male, complain of irreducible right patella dislocation with valgus knee and already done soft tissue procedure for patella dislocation. Long-leg radiographs of the right leg showed 18° valgus mechanical angle. 2nd case: A-26-years-old obese female, complain of dislocation of left patella and history of surgery for dislocation at 5 years old. Long-leg radiographs of the right leg showed 11° valgus mechanical angle. DISCUSSION: After knowing the cause of the patellar dislocation from history taking, physical and supporting examination, we performed lateral open wedge distal femoral osteotomy also MPFL and MCL reconstruction, and tibial tuberosity medialization osteotomy. There is improvement mean score in Tegner Lysholm Knee Scoring system and IKDC Scoring at 6 months after surgery. CONCLUSION: Lateral open wedge distal femur osteotomy combine with MPFL and MCL reconstruction and tibial tuberosity medialization realignment procedure can be successfully done for improve irreducible patellar dislocation in valgus knee, from clinical and radiological evaluation have good outcome after surgery.