Comparative Study Of Outcomes Research Articles

Comparative Study of the Short-Term Outcomes and Long-Term Outcomes using Total 3D and 2D Laparoscopic Distal Gastrectomy with Delta-Shaped Anastomosis for Gastric Cancer

Comparative Study of the Short-Term Outcomes and Long-Term Outcomes using Total 3D and 2D Laparoscopic Distal Gastrectomy with Delta-Shaped Anastomosis for Gastric Cancer

Primary Effusion Lymphoma (PEL) and Primary Effusion-like Lymphoma (PEL-LL): A Comparative Study of Clinicopathologic Features and Outcomes

Background: While PEL is a well-established distinct WHO entity, PEL-LL is poorly defined and has been characterized differently by different researchers. Over the years, it encompassed PEL that expressed mature B-cell markers, extra-cavitary solid PEL, and recently the HHV8-unrelated PEL-like lymphomas. For this study, we defined PEL-LL as PEL-like lymphomas expressing mature B-cell phenotype. We conducted this study to compare the clinicopathological characteristics of PEL and PEL-LL and their impact on clinical outcomes. Methods: To study the clinicopathologic characteristics, therapeutic interventions, overall survival (OS), disease-free survival (DFS), and prognostic factors, we compiled a pooled database of 381 cases of PEL and PEL-LL. Chi-square and t-test were used to test the statistical significance of differences in parameters. Kaplan-Meier survival curves were constructed. Cox proportional hazards model and Log-rank tests were used to assess the influence of clinicopathologic factors on OS and DFS. Results: A total of 381 (268 PEL, 113 PEL-LL) patients were identified. PEL and PEL-LL median ages were 51 and 74 (p < 0.0001), respectively. There was a male preponderance with M:F of 7 with PEL versus 2 with PEL-LL (p < 0.0001). The median OS was 6 months for PEL and 16 months for PEL-LL (p = 0.006). Compared to the thoracic cavity, involvement of the peritoneal cavity was associated with worse OS in both PEL and PEL-LL. Still, PEL-LL maintained better outcomes for each risk group (24 and 7 vs. 11 and 4 months, p < 0.0001). In the absence of HIV infection, PEL-LL has a superior OS to PEL (19 vs. 6 months, p = 0.002). However, HIV infection erases this survival advantage (6 vs. 6.5 months). In both entities, active treatment was associated with better OS (19 vs. 10 and 9 vs. 2 months, p < 0.0001). However, the untreated PEL-LL arm did as well as the treated PEL arm. Achieving CR as the best response to therapy in both PEL-LL and PEL was associated with superior OS (108 vs. 7 and 70 vs. 2 months, p < 0.0001). While dose-intense chemotherapy regimens did not impact OS in PEL-LL, they were associated with better OS in PEL (22 vs. 18 and 15 vs. 8 months, p = 0.03). Conclusions: This is the first study to compare PEL and PEL-LL expressing mature B-cell phenotype. It identifies key factors that impact OS that vary between the two entities. It also supports that PEL and PEL-LL represent two different disease entities regardless of their similar presentation.

A Comparative Study of Clinical Characteristics, Cytogenetic Abnormalities and Outcomes Among Multiple Myeloma, Primary Light-Chain Amyloidosis and Multiple Myeloma with Concurrent AL Amyloidosis

Introduction: Multiple myeloma (MM) and light-chain (AL) amyloidosis are both plasma cell dyscrasias and may coexist in the same patients, contributing to distinct clinical outcomes. Although they share a similar spectrum of cytogenetic abnormalities (CA), the distribution and prognostic value of these aberrations are varied. The use of fluorescence in situ hybridization (FISH) in predicting outcomes for MM is well established, while the prognostic value of CA in AL amyloidosis, notably in MM with concurrent AL amyloidosis, is still evolving. This study aimed to evaluate the outcomes of patients with MM, AL amyloidosis and coexistence of the two disorders, and address the landscape and prognostic implication of CA in patients with these 3 types of plasma cell dyscrasias. Methods: A total of 902 consecutive patients with newly diagnosed MM between January 2007 and October 2021 or AL amyloidosis between January 2007 and June 2023 were retrospectively included. Patients were classified as MM alone, MM with coexistent AL amyloidosis (MM-AL) or primary AL amyloidosis alone (pAL-alone). The presence of symptomatic MM was based on the International Myeloma Working Group (IMWG) criteria and the diagnosis of AL amyloidosis was confirmed by Congo-red-positive biopsy and immunoelectron microscopy study of the amyloid. Demographic and clinical characteristics, FISH results, along with real-world effectiveness outcomes including best hematologic response, overall survival (OS), and progression free survival (PFS) were assessed. Results: Of the 902 patients enrolled, 658 patients were in the MM-alone group, 99 in the MM-AL group and 145 in the pAL-alone group. The three groups share a similar incidence rate of CA, while the prevalence of t(11;14) was significantly higher in pAL-alone group than MM-AL and MM-alone group (41.0% vs. 24.5% vs. 16.6%, p<0.001), and the prevalence of del13q14, gain1q21 and IMWG high-risk cytogenetic abnormalities [HRCA, including t(4;14), t(14;16) and del17p] decrease in turn in MM-alone, MM-AL and pAL-alone group(del13q14, 46.4% vs. 38.1% vs. 29.7%, p=0.005; gain1q21, 52.6% vs. 46.4% vs. 27.8%, p<0.001; HRCA, 27.5 % vs. 17.2 vs. 7.6%, p<0.001) (Table). In patients with AL amyloidosis with or without coexisting MM, presence of del13q14 was associated with higher level of baseline bone marrow plasmacytosis and difference in involved and uninvolved free light chain (dFLC). Compared with the MM-alone group, a significantly lower proportion of the MM-AL group achieved hematologic response (90.4% vs. 67.7%, p<0.001) and very good partial remission (VGPR, 44.6% vs. 68.9%, p<0.001). The OS of patients with MM-AL was significantly inferior to patients with MM-alone (median, 25.2 months vs. 96.8 months, p<0.001) or pAL-alone (median, 25.2 months vs. not reached, p<0.001 )(Figure B), while patients with MM-alone has shorter PFS than AL amyloidosis irrespective of the presence or absence of MM (MM-alone vs. pAL-alone: median, 56.8 months vs. not reached, p=0.007; MM-alone vs. MM-AL: median, 56.8 months vs. not reached, p=0.515) (Figure A). Other than MM-alone group, no significant difference in PFS and OS was found between pAL patients with and without HRCA, as well as the MM-AL group, indicating the difference in prognostic implications of common HRCAs among the three groups. When stratified by the type of plasma cell disorders and status of t(11;14) (a CA that strongly related to poor outcome of pAL), patients with MM-AL and t(11;14) presented the worst OS (median, 8.2 months, p<0.001) (Figure C). Conclusion: This comparative study presented an apparent discrepancy in distribution and prognostic role of CA in different plasma cell dyscrasias. Comparing with patients with MM-alone and pAL-alone, MM-AL patients, notably with the presence of t(11;14), had the poorest survival.

Comparative Study of Clinical Outcome of Low Pressure Versus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy at Birat Medical College Teaching Hospital (BMCTH)

Introduction: Laparoscopic cholecystectomy at standard pressure pneumoperitoneum ( 12-15 mmHg of Co2) is standard of practice among surgeons. The increase in intraabdominal pressure by insufflation of carbon dioxide during laparoscopy brings certain changes in function of cardiopulmonary systems and also leads to postoperative pain due to stretching of the diaphragm.
 Objective: To minimise this impact on human physiology there is increasing effort of performing laparoscopic cholecystectomy at low pressure pneumoperitoneum (8mm Hg) however its safety has not been established. This study aims to compare outcomes of laparoscopic cholecystectomy at low pressure pneumoperitoneum versus standard pressure pneumoperitoneum in people undergoing laparoscopic cholecystectomy in terms of intraoperative time, postoperative pain including shoulder tip pain and length of hospital stay.Methodology: This descriptive randomised prospective study was conducted from Feb 2023 to Aug 2023 in the department of general surgery, BMCTH in patients diagnosed with symptomatic gallstone disease meeting inclusion criteria and willing for laparoscopic cholecystectomy. All patients were prospectively randomized into two groups randomly by the lottery method. A convenient sampling method was used. Group A odd number patients underwent surgery under low pressure (LPPLC group), Group B patients at standard pressure pneumoperitoneum (SPPLC).
 Results:A total of 145 patients (114 female and 31 male) with mean age 44.99 years of presentation. 73 patients underwent surgery under LPPLC group and 72 under SPPLC group. Mean pain recorded as per VAS score at 6, 12, 24 and 36 hours postoperatively showed no significant difference in pain among two groups with p value 0.972,0.121,0.212,0.072 respectively. Shoulder tip pain and additional need of analgesia was significantly less in LPPLC group, p value 0.002 and 0.015 respectively. No significant difference was observed in terms of operating time p value 0.151.Conversion between two groups p value 0.494 suggested no significant difference between two group.
 Conclusion:LPPLC is feasible, safe and can be considered over SPPLC. LPPLC is non inferior to SPPLC in terms of postoperative pain including shoulder tip pain and additional need of analgesia.

Comparative study of children's mental health outcomes in Tyrol, Austria, and South Tyrol, Italy, during the COVID-19 pandemic.

This study aimed to compare the mental health outcomes of children in North Tyrol, Austria, and South Tyrol, Italy, during the coronavirus disease 2019 (COVID-19) pandemic, considering the sociocultural and contextual differences between the two regions. The Tyrolean COVID-19 Children's Study (TCCS: n = 401; June 2021 to July 2021) and the Corona and Psyche in South Tyrol 2021 Study (COP‑S; n = 3402; May 2021 to June 2021) were used for data analyses. Both studies employed cross-sectional designs and collected data through online questionnaires completed by children aged 7-13years and their parents. Various psychosocial assessment tools including the Child and Adolescent Trauma Screening, Children Anxiety Test, Child Behavior Check List, Screen for Child Anxiety Related Emotional Disorders, and Health Behaviour in School-Aged Children were used in the surveys. The comparison between North Tyrol and South Tyrol revealed no significant differences in perceived threats, trauma, or anxiety among children. Similarly, there were no substantial disparities in psychosomatic complaints, indicating similar manifestations of emotional distress across the two regions. The comparative analysis of children's mental health outcomes in North Tyrol and South Tyrol during the COVID-19 pandemic confirmed the analogous influence of sociocultural and contextual factors on their wellbeing. Despite presumable variations in pandemic events, management strategies, and healthcare systems, the study suggests comparable resilience among children and highlights the importance of sociocultural factors in shaping their wellbeing. The findings emphasize the need for comprehensive understanding and targeted interventions to support children's mental health during challenging times.

Phonological awareness training and phonological therapy approaches for specific language impairment children with speech sound disorders: a comparative outcome study.

Children with specific language impairment (SLI) might present with speech sound disorder (SSD) and phonological awareness (PA) deficits which put them at risk of potential reading problems. This work aimed to organizean intervention program in Arabic forphonologicaltraining and to assess the effect of PA training versus the phonological therapy (PT) for children with SLI and SSD. The study was carried out on 60 children with comorbid SLI and SSD, aged 5-7 years. Children were equally divided into two groups; each group received language therapy combined with (PT or PA training). Measures of language development, phonological output, and PA were taken before therapy and at 4 month post-therapy for all children. The two therapy groups made nearly the same amount of progress in the development of language and phonological production, with no significant differences regarding language age and percent of consonants correct (PCC). The PA training group progressed more on the PA skills than children who received PT over the same time. PA training could facilitate the development of phonological skills by targeting the child's awareness of phonemes and improving the production of sound patterns.

Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes.

We evaluate postoperative complications, aesthetic results and satisfaction outcomes in patients with breast cancer after intervening with a skin-sparing or nipple-sparing mastectomy with an immediate prosthetic reconstruction with or without a biological mesh. Patients with multifocal breast cancer, ductal carcinoma in situ with an indication for a mastectomy and cT2 tumors with no response to primary systemic treatment were included, whereas patients aged >75 years, with inflammatory carcinoma, and severe circulatory disorders were excluded. Patients in the control group were reconstructed using a prosthesis, whereas the study group included patients reconstructed using a prosthesis and biological acellular porcine dermal mesh (Strattice™). In both groups, the result was assessed using the BREAST-Q instrument. A total of 51 patients (62 intervened breasts) were included in the study group and 38 patients (41 intervened breasts) in the control group. Implant loss and removal occurred in three patients in the study group (5.9%) and nine patients in the control group (24.3%; p = 0.030). Infections appeared in three patients in the study group (4.8%) and three patients in the control group (7.3%; p = 1.00). Skin necrosis appeared in 5 patients in the study group (12.2%) and 11 patients in the control group (21.6%; p = 0.367). Seroma appeared in five patients in the study group (12.2%) and five patients in the control group (8.1%; p = 0.514). The BREAST-Q questionnaire is a comparison between both groups regarding "satisfaction with breasts after surgery" (p = 0.026), "sexual well-being after intervention" (p = 0.010) and "satisfaction with the information received" (p = 0.049). We have noted a statistically significant decrease in implant loss in women receiving an implant with a biological mesh. A higher satisfaction was observed in patients reconstructed using Strattice™, with statistically significant differences in three items.

Results of a clinical trial of humeral neck osteosynthesis with carbon – carbon composite material

The metals utilized in the production of various implants in traumatology possess all the required mechanical properties. However, these materials are susceptible to oxidation. Carbon-carbon composites, on the other hand, exhibit X-ray transparency and are easily machinable. Thanks to their intricate yet essential physical, mechanical, and chemical properties, they find effective application in osteosynthesis and endoprosthesis procedures for bone structures. The aim of this study is to comparative view of the treatment outcomes for patients with fractures of the proximal part of the humerus by carbon-carbon composite material plates and titanium plates. Materials and methods. In this study, a carbon-carbon composite material plate was conducted osteosynthesis of the proximal part of the shoulder. In the comparison group, a titanium plate was employed. The study group comprised 20 patients, while the comparison group included 15 patients. The analysis of the results was carried out utilizing the Constant–Murley scale and the Quick DASH questionnaire. Results. A comparative study of treatment outcomes between the main and comparison groups revealed a more significant positive treatment effect in the group that underwent osteosynthesis of the humeral neck by a carbon-carbon composite material plate. This effect was observed at the 3-month, 6-month, and 12-month evaluation points. It was characterized by reduced shoulder pain, alleviated dysfunction manifestations, enhanced daily activities, and improved overall quality of life among patients in this group. Conclusions. The analysis of long-term treatment outcomes for proximal humerus fractures, utilizing both carbon-carbon composite material plates and titanium plates, by the Constant–Murley scale and the Quick DASH questionnaire, demonstrated statistically confirmed improvements in shoulder joint function for both treatment methods.

Comparative study of functional and radiological outcomes of the usage of two devices, derotation type cephalomedullary nail and the helical blade type in unstable intertrochanteric fractures in the geriatric population at a tertiary-level center

Background: Intertrochanteric fracture is a common osteoporotic fracture among elderly populations in an aging society. Early surgical fixation on these aging patients has been proposed recently for early rehabilitation and has had a positive impact on reducing comorbidities. For unstable fractures, intramedullary implants generally present biomechanical advantages over their extramedullary counterparts. Methods: The study was a 2 years prospective comparative study from 1st December 2020 to 1st December 2022 conducted in the department of orthopaedics, Rajendra institute of medical sciences, Ranchi, Jharkhand, India. Total number of patients were 50, PFN done in 25 cases and PFN-A2 in another 25 cases. Results: Mean age is 64.4 years in PFN group as compared to 67.3 years in PFN-A2 group. PFN-A2 was done in 84% male while PFN in only 76 % male and in both groups right side was mostly affected. Average surgery time, amount of blood loss, average number of C-arm shoot was more in PFN group. Conclusions: In this study of 50 patients, 25 treated by PFN and 25 by PFN-A2, it was concluded that PFN-A2 was a better construct to treat patients of older age group having osteoporosis because here reaming was not done and helical blade was inserted by hammering which caused compaction of bones in head and neck region.

BIO-RSA vs metal augmented baseplate in shoulder osteoarthritis with multiplanar glenoid deformity: a comparative study of radiographic findings and patient outcomes.

Reverse shoulder arthroplasty (RSA) requiring extensive reaming to address severe glenoid bone loss increases the risk of glenoid medialization and baseplate failure. We hypothesized that i) metal augmented baseplate prevents the medialization of the joint line and preserves glenoid bone stock similarly to BIO-RSA; ii) bone graft viability and healing in BIO-RSA patients become compromised over time. Eighty-one patients (83 shoulders) underwent glenoid lateralization with bone (BIO-RSA group, 44) or metal augmented baseplate (MIO-RSA group, 39) and a minimum follow-up of 24 months were included. The orientation and direction of glenoid erosion was identified and recorded using computerized 3D planning. Active range of motion, and the Western Ontario Osteoarthritis of the Shoulder (WOOS) index were assessed before arthroplasty and at the last follow-up visits. Radiographic changes around the glenoid and humeral components were assessed. Healing and thickness of bone graft were evaluated by predefined criteria. Postoperative global glenoid inclination (β angle) and retroversion were also measured. Delta scores of active anterior elevation were higher in the MIO-RSA group (p= 0.027). The differences in the other planes of shoulder motion and in WOOS index scores between the groups were not significant. Preoperative glenoid retroversion was higher in BIO-RSA patients, glenoid inclination was similar in both groups. Type B2 and B3 glenoids had a posterior-central (91%) and posterior-superior (90%) erosion with a mean posterior humeral head subluxation of 76% and 78%, respectively. The direction of erosion in Type E2 and E3 glenoids was posterior-superior, with a mean posterior humeral head subluxation of 74%. The rate of high position of the glenosphere was higher in the BIO-RSA group (p = 0.022), while the values of β angle and postoperative retroversion were similar in the two groups. BIO-RSA group showed radiolucent lines < 2mm around the bone graft in 16 patients (36.4%) and decreased thickness in 15 (34.1%). Incomplete baseplate seating was found in 4 MIO-RSA patients (10%). We found higher rate of humerus condensation lines in MIO-RSA patients (p= 0.01) and higher rate of cortical thinning and tuberosity resorption in the BIO-RSA group (p= 0.027 and p = 0.004, respectively). Metal augmented glenoid is a suitable alternative to BIO-RSA to preserve bone and prevent the medialization of the joint line in arthritic glenoid with multiplanar glenoid deformity. Bone and metal augmentation provided satisfactory clinical outcomes. Bone graft resorption in BIO-RSA patient raise concern about the risk of baseplate loosening and requires further long term studies.

Minimally Invasive Surgical Versus Transcatheter Aortic Valve Replacement: A Retrospective Observational Single-Center Study in Japan.

This study aimed to compare the outcomes of minimally invasive aortic valve replacement (MICS-AVR) versus transfemoral transcatheter aortic valve replacement (TF-TAVR) in Asian patients. We conducted a retrospective, observational, single-center study in Japan, including cases of MICS-AVR (n = 202) and TF-TAVR (n = 248) between 2014 and 2021. In a total of 450 cases, propensity score matching was performed at a ratio of 1:1, resulting in 96 pairs. Furthermore, we performed competing-risk regression and mediation analyses to determine the treatment effect on outcomes of interests, considering death as a competing risk, and to evaluate the mediation effect of paravalvular leak (PVL) severity. There were similar incidences of all-cause death, cardiac death, stroke and cerebral hemorrhage, and aortic valve reintervention between the 2 groups. However, the TF-TAVR cohort had a longer hospital length of stay and higher rates of significant PVL compared with the MICS-AVR cohort. Multivariable-adjusted Cox regression analyses revealed that heart failure hospitalization (hazard ratio [HR] = 0.129, 95% confidence interval [CI]: 0.038 to 0.445, p = 0.001) and permanent pacemaker implantation (HR = 0.050, 95% CI: 0.006 to 0.409, p = 0.005) favored MICS-AVR. Competing-risk regression analyses confirmed similar findings. All outcomes were unrelated to PVL severity. To our knowledge, this is the first comparative study of clinical outcomes in Asian patients undergoing MICS-AVR versus TF-TAVR, revealing that MICS-AVR could be a feasible and efficient alternative to TF-TAVR. Future larger-scale randomized controlled trials are needed to validate the present results.

Poorer outcomes associated with more invasive lead management strategies for Abbott Riata® leads: a large, multicenter experience.

Over 100,000 Abbott Riata® were implanted in the United States before they were recalled in 2010. There are still a significant number of Abbott Riata® leads in use, and it is unclear how these leads should be managed at the time of generator change or lead malfunction. Although data comparing both Sprint Fidelis® and Abbott Riata® leads in this setting is available, there are no multicenter comparative studies of outcomes for various lead management strategies, including lead extraction (LE), lead abandonment/revision (LA), and generator change (GC)only at the time of device at elective replacement interval(ERI) for Abbott Riata® leads. A retrospective, multicenter study was undertaken to compare short-term outcomes (major complications-MC, death, extended or re-hospitalizations within 60days-RH, lead malfunction-LM) and total outcomes (short-term outcomes & lead malfunction during follow-up) of patients with Riata® leads undergoing LE, LA, or GC. 152 patients (65 ± 13years, 68% male) were followed for a mean 33 ± 30months following intervention. Out of 166 procedures,13 patients underwent LE, 16 patients underwent LA, and 137 patients underwent GC. There was 1 major complication in each group, yielding an event rate of 7.7% for LE, 6.3% for LA, and 0.7% for GC cohorts. There were significantly more short-term and total adverse outcomes in the group of patients getting LE and LA versus GC only (38.5% & 31.3% vs 7.3%, P < 0.001). Total Riata® lead dwell time follow-up was 17,067months. A total of 3 Riata® lead malfunctions were noted during long-term follow-up. Inappropriate shocks were similar between LE 7.7% (1/13), LA 6.3% (1/16). and GC 11.0% (4/136); P = 0.57. There were more short-term and total adverse outcomes in more invasive management strategies (LE and LA) versus GC alone. The failure rate of Riata® leads was substantially lower compared to previous reports. Therefore, we recommend only performing battery exchange when a device with an active Riata® lead is at ERI, unless there is malfunction of the Riata® lead noted on testing.

Technique Variation in the Surgical Treatment of Lateral Ankle Instability.

Lateral ankle sprains are the most common type of injury to the ankle and can lead to ankle instability. There are many described techniques for the surgical treatment of lateral ankle instability. The purpose of this study is to quantify the variation in surgeon technique for lateral ankle instability treatment. Surveys were sent to 62 orthopaedic foot and ankle surgeons regarding surgical technique for the treatment of lateral ankle instability. Clinical agreement was defined as greater than 80% agreement to assess the cohesiveness of surgical methods as described by Marx et al. Results. Response rate was 49/62 (79%). There was clinical agreement for not using bone tunnels and not using metal anchors. All other factors lacked clinical agreement. A greater average number of throws and knots (4.2 for each, range 1-6 throws, range 2-12 knots) were used by surgeons that do not believe knots cause pain compared to an average of 3.9 (range, 1-6) throws and 4.0 (range, 2-15) knots by surgeons who do believe knots cause pain. The association that surgeon who believed knots do cause pain and thus used fewer knots and throws was not statistically significant (P > .05). The preferred material by surgeons in our study are as follows: nonabsorbable braided suture (26/49, 53%), suture tape (15/49, 31%), and fiber tape (4/49, 8%). Among surgeons who use absorbable suture (34/49, 69%), there was no significant difference (P > .05) between surgeons who believe knots cause pain (23/34, 68%) and those who do not (11/34, 32%). Among this small sample of orthopaedic foot and ankle surgeons, there is wide variation in surgical technique for lateral ankle instability treatment and little agreement on the clinical standard of care. This disagreement highlights the need for comparative outcome studies in the treatment of ankle instability. Level III: Retrospective cohort study.

Prospective observational comparative study of outcomes between single-layer versus double-layer gastrointestinal anastomosis

Prospective observational comparative study of outcomes between single-layer versus double-layer gastrointestinal anastomosis

Zancolli Lasso Technique Versus Brand Technique in Hand Clawing: A Comparative Study of Functional Outcomes

Zancolli Lasso Technique Versus Brand Technique in Hand Clawing: A Comparative Study of Functional Outcomes

626 Timing of Pseudomonas aeruginosa acquisition in children diagnosed with cystic fibrosis recruited in the Irish Comparative Outcome Study Part 2

626 Timing of Pseudomonas aeruginosa acquisition in children diagnosed with cystic fibrosis recruited in the Irish Comparative Outcome Study Part 2

A Comparative Study of Clinical Outcomes Between Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty: A Propensity Score-Matched Cohort Study.

We investigated a comparison of clinical outcomes between cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty. However, it is still controversial which design leads to better clinical results. In clinical settings, choosing either CR or PS is likely based on the surgeon's preferences. In this study, short-term clinical outcomes between CR and PS in patients who received a single knee prosthesis were compared using propensity score matching. Two hundred and twelve CR and 43 PS of a single knee prosthesis were enrolled in this study. After propensity score matching, 34 knees each in the CR and PS groups were chosen and were without significant differences in age at operation, gender, BMI, preoperative range of motion (ROM), preoperative femorotibial angle (FTA), and presence or absence of patellar replacement. Clinical scores, including ROM, Knee Society score (KSS), knee injury and osteoarthritis outcome score (KOOS), except for the sports subscale, were compared between the CR and PS groups preoperatively and two years postoperatively. Postoperatively, there were no significant differences in FTA, ROM, or KSS. Preoperative scores for the KOOS except for the pain subscale were comparable between the groups. Postoperatively, however, the PS group had a significantly higher score in the ADL subscale compared to the CR group (PS: 89.5 vs. CR: 80.8,p= 0.017). The KOOS subscales other than activities of daily living (ADL) were comparable between the groups. In this propensity score-matched cohort study, PS showed a better outcome for the ADL than the CR design. These findings suggest that choosing either CR or PS should not depend on the surgeon's preferences. A PS design may be preferable to CR for elderly patients.

A comparative study of anatomical and functional outcomes after 20, 23 and 25 gauge pars plana vitrectomy in adult population at a tertiary care center in Rajasthan

Pars plana vitrectomy is the most common technique in vitreoretinal surgery that enables access to the posterior segment for treating conditions such as retinal detachment, vitreous hemorrhage, macular hole, endophthalmitis, dropped nucleus and dropped iol in a controlled closed system.Prospective, comparative study of patients, more than 18 years of age, who underwent pars plana vitrectomy for various vitreoretinal disease at J.L.N. Medical College, Ajmer, from October 2020 to March 2022,with no previous history of any vitreoretinal surgery.96 eyes of 96 patients that underwent 20-gauge (n=32), 23-gauge (n=32) and 25-gauge (n=32) Pars plana vitrectomy were included in this study. The mean duration of surgery was significantly higher in the conventional 20-Gauge as compared to the micro incisional vitrectomy system. Mean Best corrected visual acuity (BCVA) improved significantly in all three groups at postoperative 3 months, no significant difference between the 3 groups. Re retinal detachment occurs in 6 eyes(2 eyes in each group). Recurrent vitreous hemorrhage occurs in 1 eye in 25-gauge and postoperative endophthalmitis occurs in 2 eyes(1 eye each in 20-gauge and 23-gauge). There was a similar rate of ocular hypertension in all three groups. Postoperatively 20-gauge showed significantly higher mean conjunctival hyperemia and subconjunctival hemorrhage compared to Sutureless microincisional vitrectomy surgery.Functional and anatomical outcomes assessed by BCVA and retinal status postoperatively seem to be comparable between 20,23 and 25-gauge vitrectomy systems. Sutureless microincisional vitrectomy surgery showed significantly shorter duration of surgery.

A comparative study of epidemiological characteristics, treatment outcomes, and mortality among patients undergoing hemodialysis by health insurance types: data from the Korean Renal Data System.

The prevalence of end-stage renal disease (ESRD) requiring dialysis has progressively increased. Therefore, to achieve financial stability by managing the increasing numbers of patients undergoing hemodialysis (HD), a fixed-payment system was introduced in 2001 for medical aid (MA) beneficiaries receiving HD in Korea. We identified patients in the Korean Renal Data System that received HD between 2001 and 2017 and stratified them into the following two groups: the National Health Insurance (NHI) and MA groups. Then, we compared the two groups that differed in demographic characteristics, the treatment process and outcomes, and mortality based on health insurance type. Among 52,574 patients, the number of patients aged 65 years or older, hypertension was higher in the NHI group, but diabetes was higher in the MA group. Additionally, the MA group had more weekly dialysis sessions, and expensive drugs tended to be used less frequently. Regarding treatment outcomes, including laboratory test results, the MA group achieved significantly lower goals than the NHI group (p < 0.001). Furthermore, the mortality rate per 1,000 persons was 31 and 27 in the MA and NHI groups, respectively, and the mortality rate ratio was 1.2 (95% confidence interval [CI], 1.076-1.230). Moreover, the hazard ratio for mortality was 1.39 (95% CI, 1.30-1.49, p < 0.001) after adjusting for age, sex, causes of ESRD, and comorbidities. There were significant differences in the treatment and mortality indicators between the groups. Therefore, policy support should be strengthened to provide better medical services to MA beneficiaries undergoing HD.

Intramedullary Fibular Strut Allograft and a Small Fragment Nonlocking T-plate for Periprosthetic Lateral Femoral Condyle Fracture: A Case Report

Intramedullary Fibular Strut Allograft and a Small Fragment Nonlocking T-plate for Periprosthetic Lateral Femoral Condyle Fracture: A Case Report