Clinical Efficacy of Different Bone Cement
Distribution Patterns in Percutaneous
Kyphoplasty: A Retrospective Study

Background: Bone cement distribution patterns in percutaneous kyphoplasty (PKP) is the key factor in keeping the vertebral stabilization and curative effect. However, the same cement volume can result in different bone cement distribution patterns and can thereby lead to different clinical outcomes. Therefore we investigated associations between cement distribution patterns and the occurrence rates of recompression in cemented vertebrae after PKP for patients with osteoporotic vertebral compression fractures (OVCFs). Objectives: The study focuses attention on the influence of compact and dispersive cement distribution patterns in PKP for patients with OVCFs. Study Design: A retrospective cohort study. Setting: An affiliated people’s hospital of a university. Methods: According to different cement distribution patterns, patients were assigned to 4 groups. The demographic data, radiographic data, and clinical outcomes were compared between the 4 groups. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were evaluated before and 2 days after PKP. Moreover, the relationships between bone cement and clinical outcomes were analyzed. The epidemiologic data, clinical outcomes, and complications of the 4 groups were assessed. Comparisons of the radiologic and clinical results of the 4 groups were made pre- and postoperatively. Anterior height of fractured vertebrae (AH), the kyphotic Cobb angle, and the volumetric cubage index of the fractured vertebrae were measured. Results: A total of 104 subjects were retrospectively analyzed and followed up (median age, 75.01 ± 8.42 years; age range, 56–94 years). The mean procedure duration was 61.26 ± 23.05 minutes (range, 30–140 minutes). The mean follow-up was 12.1 ± 2.2 months (range, 2–15 months). Statistically, there was no significant difference in terms of gender, age, body mass index, and bone mineral density (P > 0.05). The incidence of cement leakage was significantly lower in group A than those in the other groups. The total amount of bone cement injected into 104 cases (104 vertebral bodies in total) was 848.5 mL, and the amount of bone cement injected into a single vertebral body was 7.94 ± 1.38 mL. The amount of bone cement injection in each group was the lowest (6.80 ± 1.66 mL) in group D, followed by (7.94 ± 1.38 mL) group B, and the highest (8.96 ± 1.68 mL) in group A, with a statistically significant difference between the 4 groups (P < 0.05). No serious complications were observed during the follow-up periods. The AH and Cobb angle improved significantly for the 4 groups (P < 0.05). The VAS score decreased from 3.55 ± 0.54, 3.53 ± 0.65, 3.40 ± 0.58, and 3.40 ± 0.66 preoperatively to 0.18 ± 0.39, 0.23 ± 0.41, 0.20 ± 0.40, and 0.15 ± 0.36 at 48 hours postoperatively. The ODI score dropped from 35.65 ± 4.54, 36.45 ± 4.72, 34.12 ± 4.86, and 35.65 ± 4.34 preoperatively to 15.47 ± 1.32, 15.32 ± 1.34, 15.23 ± 1.26, and 15.73 ± 1.17 at 48 hours postoperatively. Limitations: Our estimation of the vertebral body volume is imprecise. In addition, the number of subjects with OVCFs was small in this retrospective study. The volume of the fractured vertebra was not calculated accurately. Conclusions: Significant associations between cement distribution patterns and bone cement leakage affected the clinical outcome in patients after PKP. A higher incidence of bone cement leakage was observed in patients with treated vertebrae exhibiting a single-dispersive or single-compact pattern. Key words: Percutaneous kyphoplasty, osteoporotic vertebral compression fracture, bone cement distribution patterns

Download Full-text

The Effect of Bone Cement Distribution on the Outcome of Percutaneous Vertebroplasty: A Case cohort study

10.21203/rs.3.rs-27528/v2 ◽

2020 ◽

Author(s):

Lei Tan ◽

Bingtao Wen ◽

Zhaoqing Guo ◽

Zhongqiang Chen

Keyword(s):

Bone Cement ◽

Vertebral Body ◽

Kyphotic Angle ◽

Vas Score ◽

Angle Change ◽

Significant Difference ◽

Cement Distribution ◽

Group A ◽

Group B

Abstract Background: To analyze the effect of different types of bone cement distribution after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fracture (OVCF). Methods: 137 patients with single level OVCF who underwent PVP were retrospectively analyzed. The patients were divided into two groups according to bone cement distribution. Group A: bone cement contacted both upper and lower endplates; Group B: bone cement missed at least one endplate. Group B was divided into 3 subgroups. Group B1: bone cement only contacted the upper endplates; Group B2: bone cement only contacted the lower endplates; Group B3: bone cement only located in the middle of vertebral body. The visual analogue scale (VAS) score at 24 hours post operation and last follow-up, anterior vertebral height restoration ratio (AVHRR), anterior vertebral height loss ratio (AVHLR), local kyphotic angle change and vertebral body recompression rate were compared. Results: 24 hours post operation, the pain of all groups were significantly improved. The average follow-up time was 15.3 ± 6.3 (6-24) months. At last follow-up, the VAS score of group A was lower than that of group B. There were 14 cases (10.2%) of adjacent vertebral fracture, 5 cases (8.6%) in group A and 9 cases (11.4%) in group B. There were 9 cases (6.6%) of cement leakage, 4 cases (6.9%) in group A and 5 cases (6.3%) in group B. At last follow-up, there were 16 cases (11.7%) of vertebral body recompression, including 3 cases (5.2%) in group A and 13 cases (16.5%) in group B. There was no significant difference in AVHRR between two groups. Local kyphotic angle change was significant larger in group B. At last follow-up, AVHLR in group B was higher than that in group A. In subgroup analysis, there was no significant difference in VAS score, local kyphotic angle change, vertebral recompression rate, AVHRR or AVHLR. Conclusions: If the bone cement fully contacted both the upper and lower endplates, it can better restore the strength of the vertebral body and maintain the height of the vertebral body, reduce the risk of the vertebral body recompression and long-term pain.

Download Full-text

The Effect of Bone Cement Distribution on the Outcome of Percutaneous Vertebroplasty: A Case Cohort Study

10.21203/rs.3.rs-27528/v1 ◽

2020 ◽

Author(s):

Lei Tan ◽

Bingtao Wen ◽

Zhaoqing Guo ◽

Zhongqiang Chen

Keyword(s):

Bone Cement ◽

Vertebral Body ◽

Percutaneous Vertebroplasty ◽

Vertebral Height ◽

Significant Difference ◽

Cement Distribution ◽

Post Operation ◽

Group A ◽

Group B

Abstract Background: To analyze the effect of different types of bone cement distribution after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fracture (OVCF). Methods: 137 patients withsinglelevelOVCF who underwent PVP were retrospectively analyzed. The patients were divided into two groups according to bone cementdistribution. Group A:bone cement contacted both upper and lower endplates; Group B: bone cement missed at least one endplate. Group Bwas divided into 3 subgroups. Group B1: bone cement only contacted the upper endplates; Group B2: bone cement only contacted the lower endplates; Group B3: bone cement only located in the middle of vertebral body. The visual analogue scale (VAS) scoreat 24 hours post operation and last follow-up, anterior vertebral height restoration ratio (AVHRR), anterior vertebral height loss ratio (AVHLR) and vertebral body recompression ratewere compared. Results: 24 hours post operation, the pain of all groups were significantly improved. At the last follow-up, the VAS score of group A was lower than that of group B. There were 9 cases (6.6%) of cement leakage, 4 cases (6.9%) in group A and 5 cases (6.3%) in group B. At the last follow-up, there were 16 cases (11.7%) of vertebral body recompression, including 3 cases (5.2%) in group A and 13 cases (16.5%) in group B. There was no significant difference in AVHRR between two groups. At the last follow-up, AVHLR in group B was higher than that in group A. In subgroup analysis, there was no significant difference in VAS score,vertebral recompression rate, AVHRR or AVHLR.Conclusions: If the bone cement fully contacted both the upper and lower endplates, it can better restore the strength of the vertebral bodyand maintain the height of the vertebral body, reduce the risk of the vertebral body recompression and long term pain.

Download Full-text

Percutaneous Vertebroplasty and Facet Blocking for Treating Back Pain Caused by Osteoporotic Vertebral Compression Fracture

Pain Research and Management ◽

10.1155/2020/5825317 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Yongquan Cheng ◽

Xiaoliang Wu ◽

Jiawei Shi ◽

Hui Jiang

Keyword(s):

Back Pain ◽

Bone Cement ◽

Exposure Time ◽

Percutaneous Vertebroplasty ◽

Combined Therapy ◽

Cement Leakage ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B

Background and Objectives. Back pains associated with osteoporotic vertebral compression fractures (OVCFs) may arise not just from vertebral body but also from posterior elements. Percutaneous vertebroplasty (PVP) and facet blocking (FB) combined therapy would relieve pain better, but it has not been elucidated. The purpose of this retrospective study was to compare the treatment effects of PVP and FB combined therapy with PVP alone in OVCFs patients. Methods. Clinical and radiological data of 204 patients were reviewed. The patients were divided into Group A (PVP alone) and Group B (PVP and FB combined therapy) according to treatments. Back pain was evaluated with Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). The operation, fluoroscopic exposure time, and bone cement leakage were recorded. The χ2 test, Student’s t-test, and repeated measures analysis of variance were used to compare the differences between the two groups. Results. There were 125 patients in Group A and 79 patients in Group B. Their baseline characteristics were similar (P>0.05). The mean VAS scores of Group A and Group B were 7.03 and 7.21 at admission, 4.7 and 3.2 at 1 day after operation, 4.0 and 3.0 at 3 months, and 2.2 and 2.2 at 12 months after operation, respectively. The mean ODI scores of Group A and Group B were 30.9 and 29.8 at admission, 17.6 and 17.7 at 3 months, and 10.5 and 10.9 at 12 months after operation, respectively. The mean operation time and fluoroscopic exposure time of Group A (35.6 minutes and 7.2 seconds, respectively) was significantly shorter than that of Group B (45.7 minutes and 11.7 seconds, respectively, P<0.01). The incidence of bone cement leakage and new fractures after operation did not have statistically significant difference between groups. Conclusion. PVP and FB combined therapy could provide better pain relief than PVP alone in short term after operation in patients with OVCFs associated back pains.

Download Full-text

Influence of bone cement distribution on outcomes following percutaneous vertebroplasty: a retrospective matched-cohort study

Journal of International Medical Research ◽

10.1177/03000605211022287 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110222

Author(s):

Ling Mo ◽

Zixian Wu ◽

De Liang ◽

Linqiang Y ◽

Zhuoyan Cai ◽

...

Keyword(s):

Cohort Study ◽

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Vertebral Compression Fractures ◽

Matched Cohort ◽

Matched Cohort Study ◽

Cement Distribution ◽

Group A ◽

Group B

Objective To evaluate the influence of insufficient bone cement distribution on outcomes following percutaneous vertebroplasty (PVP). Methods This retrospective matched-cohort study included patients 50–90 years of age who had undergone PVP for single level vertebral compression fractures (VCFs) from February 2015 to December 2018. Insufficient (Group A)/sufficient (Group B) distribution of bone cement in the fracture area was assessed from pre- and post-operative computed tomography (CT) images. Assessments were before, 3-days post-procedure, and at the last follow-up visit (≥12 months). Result Of the 270 eligible patients, there were 54 matched pairs. On post-operative day 3 and at the last follow-up visit, significantly greater visual analogue scale (VAS) pain scores and Oswestry Disability Index (ODI) scores were obtained in Group B over Group A, while kyphotic angles (KAs) and vertebral height (VH) loss were significantly larger in Group A compared with Group B. Incidence of asymptomatic cement leakage and re-collapse of cemented vertebrae were also greater in Group A compared with Group B. Conclusions Insufficient cement distribution may relate to less pain relief and result in progressive vertebral collapse and kyphotic deformity post-PVP.

Download Full-text

Percutaneous vertebroplasty versus kyphoplasty for the treatment of neurologically intact osteoporotic Kümmell’s disease

BMC Surgery ◽

10.1186/s12893-021-01057-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shou-qian Dai ◽

Rong-qing Qin ◽

Xiu Shi ◽

Hui-lin Yang

Keyword(s):

Blood Loss ◽

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Cement Leakage ◽

Intraoperative Blood Loss ◽

Surgical Time ◽

Significant Difference ◽

Neurologically Intact ◽

Operation Cost

Abstract Background Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell’s disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. Methods The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb’s angle were assessed by imaging. Results All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. Conclusion PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.

Download Full-text

Comparison Between With Kirschner-wires Only And Combined Screw Fixation in Proximal Reverse Chevron osteotomy(PCMO) For Hallux Valgus Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000231 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Hwa Jun Kang ◽

Hong-Geun Jung ◽

Jong-Soo Lee ◽

Sungwook Kim ◽

Mao Yuan Sun

Keyword(s):

Hallux Valgus ◽

Screw Fixation ◽

Fixation Method ◽

Kirschner Wires ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.

Download Full-text

Influence of the distribution of bone cement along the fracture line on the curative effect of vertebral augmentation

Journal of International Medical Research ◽

10.1177/0300060519864183 ◽

2019 ◽

Vol 47 (9) ◽

pp. 4505-4513 ◽

Cited By ~ 3

Author(s):

Kai Xu ◽

Ya-Ling Li ◽

Fei Song ◽

Hua-Wei Liu ◽

Hua-Dong Yang ◽

...

Keyword(s):

Pain Relief ◽

Bone Cement ◽

Compression Fracture ◽

Cement Leakage ◽

Fracture Line ◽

Vertebral Augmentation ◽

Bilateral Group ◽

Significant Difference ◽

Cement Distribution ◽

Unilateral Group

Objective The present study was performed to evaluate the effect of different bone cement distributions along the fracture line on clinical and imaging outcomes of vertebral augmentation. Methods In total, 84 patients who underwent vertebral augmentation for a single osteoporotic vertebral compression fracture from January 2016 to August 2018 were retrospectively reviewed. These patients were divided into two groups according to the relationship between the bone cement distribution and the fracture line: the unilateral group (n = 23) and the bilateral group (n = 61). Postoperative clinical and imaging parameters were compared between the two groups. Results Statistical analyses showed no significant difference in postoperative pain relief, bone cement leakage, nerve injury, or new vertebral fracture between the two groups. Significant recovery from vertebral compression was observed in the bilateral group after surgery, but there was no significant difference in vertebral compression after surgery in the unilateral group. Conclusions Pain relief was similar for different types of cement distributions along the fracture line, but a bilateral cement distribution exhibited better recovery from vertebral compression and did not increase bone cement leakage in the vertebral augmentation procedure.

Download Full-text

Clinical outcomes of arthroscopic repair of acetabular labral tears

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2017-000328 ◽

2018 ◽

Vol 4 (1) ◽

pp. e000328 ◽

Cited By ~ 4

Author(s):

Carlos César Vassalo ◽

Antônio Augusto Guimarães Barros ◽

Lincoln Paiva Costa ◽

Euler de Carvalho Guedes ◽

Marco Antônio Percope de Andrade

Keyword(s):

Clinical Outcomes ◽

Arthroscopic Repair ◽

Final Evaluation ◽

Labral Repair ◽

Harris Hip Score ◽

Senior Surgeon ◽

Labral Tears ◽

Significant Difference ◽

The Mean

PurposeTo evaluate the primary clinical outcomes of arthroscopic labral repair.MethodsAll patients who underwent arthroscopic repair of the acetabular labrum performed by a senior surgeon between October 2010 and December 2013 were invited to participate in this prospective study. Patients included were those who had a preoperative diagnosis of labral tears, a lateral centre edge greater than 25° and a labral tear believed to be suturable during the intraoperative evaluation. Patients with Tönnis grade 2 or grade 3 hip osteoarthritis and those who had undergone a previous hip surgery were excluded. All patients were evaluated using the modified Harris Hip Score (mHHS) during the final appointment before surgery, 4 months after surgery and at the final evaluation. Interviews were conducted by the senior surgeon.ResultsEighty-four patients (90 hips) underwent arthroscopic repair. The mean age was 44.2 years and the mean follow-up period was 43.0 months (minimum of 25 months and maximum of 59 months). The mean mHHS was 80.4 preoperatively, 95.0 at 4 months postoperatively and 96.6 at final evaluation. A statistically significant difference existed among these scores (p<0.001).ConclusionArthroscopic labral repair was associated with a clinically significant improvement in mHHS after short-term (4 months) and medium-term (43 months) follow-up.Level of evidenceLevel IV, therapeutic case series.

Download Full-text

Osteochondral allograft transplantation for large Hill-Sachs lesions: a retrospective case series with a minimum 2-year follow-up

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1366-8 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Hongwu Zhuo ◽

Yangkai Xu ◽

Fugui Zhu ◽

Ling Pan ◽

Jian Li

Keyword(s):

Clinical Outcomes ◽

Case Series ◽

Osteochondral Allograft ◽

Satisfaction Rate ◽

Allograft Transplantation ◽

Constant Murley Score ◽

Significant Difference ◽

The Mean ◽

Graft Resorption

Abstract Purpose To investigate the clinical outcomes after osteochondral allograft transplantation for large Hill-Sachs lesions. Methods Patients who underwent osteochondral allograft transplantation for large Hill-Sachs lesions were identified. Clinical assessment consisted of active range of motion (ROM), American Shoulder and Elbow Surgeons score (ASES), Constant-Murley score, Rowe score, and patient satisfaction rate. Radiographic assessment was performed with CT scan. Results Nineteen patients met the inclusion criteria. The mean age was 21.7 years. The mean preoperative size of the Hill-Sachs lesion was 35.70 ± 3.02%. The mean follow-up was 27.8 months. All grafts achieved union at an average of 3.47 months after surgery. At the final follow-up, graft resorption was observed in 43.1% of patients. The average size of residual humeral head articular arc loss was 12.31 ± 2.79%. Significant improvements (P < .001) were observed for the active ROM, ASES score, Constant-Murley score, and Rowe score. The overall satisfaction rate was 94.7%. No significant difference was found between the resorption group and the nonresorption group in postoperative clinical outcomes. Conclusion Osteochondral allograft transplantation is a useful treatment option for patients with large Hill-Sachs lesions. Although the incidence of graft resorption may be relatively high, the clinical outcomes at a minimum 2-year follow-up are favorable. Level of evidence Level IV, case series

Download Full-text

Clinical results of Visian implantable collamer lens implantation according to various sizes and implantation angles

European Journal of Ophthalmology ◽

10.1177/11206721211033468 ◽

2021 ◽

pp. 112067212110334

Author(s):

Bu Ki Kim ◽

Young Taek Chung

Keyword(s):

Case Series ◽

Clinical Results ◽

Implantable Collamer Lens ◽

Retrospective Case ◽

Significant Difference ◽

Lens Implantation ◽

Group A ◽

The Mean ◽

Group B

Purpose: To investigate the clinical outcomes of Visian implantable collamer lens (ICL) implantation according to lens size and implantation angle. Setting: Onnuri Smile Eye Clinic, Seoul, Republic of Korea. Design: Retrospective case series. Methods: This study included 566 eyes of 283 patients treated with ICL implantation. Patients were divided into three groups: horizontally implanted same-sized ICL (group A), horizontally implanted different sized-ICL (group B: large ICL and small ICL) and same sized-ICL implanted with a different implantation angle (group C: horizontal and vertical). Results: At 12-month follow-up, the mean vault was 0.78 ± 17, 0.48 ± 0.13, 0.71 ± 0.18 and 0.44 ± 0.16 mm when large and small sized ICL was used in group B ( p < 0.001), and when ICL was horizontally and vertically implanted in group C ( p = 0.021), respectively. And the mean SE was −0.11 ± 0.30, −0.34 ± 0.42, −0.3 ± 0.56 and −0.64 ± 0.66 dioptres (D), when the large and the small sized ICL was used group B ( p = 0.039), and when the ICL was horizontally and vertically implanted in group C ( p = 0.036), respectively. No significant difference in UDVA, IOP and ECD between both eyes in groups B and C was observed. No statistical difference was found in the vault between both eyes for groups B and C. Conclusions: The vault was significantly higher and the SE was significantly more hyperopic when a larger-sized ICL was used or the ICL was horizontally implanted compared to when the ICL was vertically implanted.

Download Full-text