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Total knee arthroplasty (TKA) for patients with valgus deformity (> 10 degrees) is technically challenging and has produced variable clinical results in terms of deformity correction, instability, and overall outcomes. The lateral parapatellar approach (LPA) is an alternative to the traditional medial parapatellar approach with potential advantages of direct access for release of tight lateral ligamentous structures with preservation of the medial structures, optimized patellar tracking, preserved medial blood supply to the patella, and less use of constrained implants. We present a case series of a single institution's experience with use of a modified LPA using a Z-capsuloplasty for 35 primary TKA cases in 30 patients with osteoarthritis and Ranawat's type-II fixed valgus deformity with attenuation of medial soft tissues. The mean age of patients was 64.8 years (range: 42–78 years). Follow-up duration was a mean of 47.3 months (range: 3–130 months). The patients were assessed pre- and postoperatively using radiographic measurement of the anatomic femorotibial angle (FTA) and clinical measurement of range of motion (ROM) and the Chinese knee society score (KSS). Complications and reoperations were recorded. The mean coronal alignment was corrected from 20.4 degrees of valgus (range: 11.3–42 degrees) preoperatively to 7.0 degrees of valgus (range: 3.6–15.1 degrees) postoperatively. One case required use of a constrained condylar design implant. At a mean of 47.3 months, the mean Knee Society objective and functional scores improved to 91.8 ± 6.6 and 84.3 ± 18.2 points, respectively. Mean ROM was 94.9 degrees preoperatively and 105.7 degrees postoperatively. Three cases (8.6%) had postoperative complications, including transient common peroneal nerve palsy, hematoma, and deep infection. One patient underwent two-stage revision for infection. There were no cases of late instability. The modified LPA using a Z-capsuloplasty is a reproducible and effective surgical technique for performing TKA in the setting of osteoarthritis and severe valgus deformity.

The thalamus and central dopamine signaling have been shown to play important roles in high-level cognitive processes including impulsivity. However, little is known about the role of dopamine receptors in the thalamus in decisional impulsivity. In the present study, rats were tested using a delay discounting task and divided into three groups: high impulsivity (HI), medium impulsivity (MI), and low impulsivity (LI). Subsequent in vivo voxel-based magnetic resonance imaging revealed that the HI rats displayed a markedly reduced density of gray matter in the lateral thalamus compared with the LI rats. In the MI rats, the dopamine D1 receptor antagonist SCH23390 or the D2 receptor antagonist eticlopride was microinjected into the lateral thalamus. SCH23390 significantly decreased their choice of a large, delayed reward and increased their omission of lever presses. In contrast, eticlopride increased the choice of a large, delayed reward but had no effect on the omissions. Together, our results indicate that the lateral thalamus is involved in decisional impulsivity, and dopamine D1 and D2 receptors in the lateral thalamus have distinct effects on decisional impulsive behaviors in rats. These results provide a new insight into the dopamine signaling in the lateral thalamus in decisional impulsivity.

Background: With the increasing prevalence of overweight and obesity, adult-acquired buried penis is more common in recent years. Many surgical techniques have been reported. However, none is the gold standard. Objective: To evaluate the safety and efficacy of combining suprapubic liposuction and modified Devine’s technique for penile lengthening in adult patients with buried penis due to obesity Methods: From September 2015 to June 2018, 26 consecutive suitable patients (mean age: 33 ± 5.7 years, mean body mass index: 29 ± 5.4 kg/m2) with a buried penis received suprapubic liposuction and modified Devine’s technique for penis release in our medical centre. A retrospective study was conducted. Their penile length from tip to the skin (flaccid) was measured pre- and post-operatively. The amount of liposuction was also recorded accordingly. Results: The mean length of the follow-up on the 26 patients is 18 ± 7.1 months (range 3-33 months). The average amount of liposuction is 450 ± 90.2 mL. The average penile length measured preoperatively, post-operatively (on table), and 3 months after the operation is 2.9 ± 1.3, 7.4 ± 2.1, and 5.3 ± 1.8 cm, respectively. The post-operative penile length had significantly increased by 4.5 ± 1.6 cm (on table) and 2.4 ± 0.7 cm (3 months post-operation) with a P value <.05. No patient had difficulties in sexual intercourse or urination post-operatively. None of the patients were dissatisfied with their surgical outcomes. Conclusions: The combination of suprapubic liposuction and modified Devine’s technique is a safe and effective method for releasing the buried penis of adults with satisfying outcomes.