Consecutive Group Research Articles

Comparison of warfarin with direct oral anticoagulants for thromboembolic prophylaxis after catheter ablation of ventricular tachycardia.

Thromboembolic events after catheter ablation of ventricular tachycardia (VT) can result in significant morbidity. Thromboembolic prophylaxis after catheter ablation can be achieved by the use of antiplatelet agents, vitamin K antagonists, or direct oral anticoagulants (DOACs). The relative safety and efficacy of these modes of prophylaxis are uncertain. We sought to compare the outcomes of patients who received warfarin or DOACs for thromboembolic prophylaxis after catheter ablation of VT. Anticoagulation with DOACS was started after left ventricular VT ablation in a series of 42 consecutive patients with structural heart disease (67 ± 11 years, 3 women, ejection fraction 32 ± 14%). Duration of hospital stay, bleeding episodes, and thromboembolic events were compared to a historic consecutive group of patients (n = 38, 65 ± 13 years, 14 women, ejection fraction 36 ± 13%) in whom anticoagulation with a formerly described protocol of heparin and vitamin K antagonist was used after VT ablation procedures. Hospital stay was significantly shorter in the group where DOACs were used as compared to vitamin K antagonists (3.3 ± 1.8 vs. 5.0 ± 2.5 days postablation; p = 0.001) without an increase of bleeding or thromboembolic events. Anticoagulation with DOACs is safe and shortens hospital stay in patients with structural heart disease undergoing left ventricular VT ablation procedures.

Normal Glanular and Meatal Measurements in Boys and Men

ObjectiveTo determine the normal vertical urethral meatus length (ML), maximum glanular width (MGW), the glanular seam length (between the lowest edge of urethral meatus and the glans closure line corona) (GSL) and GSL/ML ratio in all age groups. Materials and MethodsConsecutive patients presented to urology and pediatric urology outpatient clinics were included in the study. Penile abnormalities, known endocrinological disorders, history of penile/urethral surgery were excluded. MGW, ML, and GSL were measured with a caliper. Glanular and meatal measurements were compared according to ages. ResultsA total of 1398 boys and men (380 (27.18%) prepubertal (1-12), 203 (14.52%) adolescent (13-19), and 815 (58.30%) postpubertal (19-93)) with a median age of 31 years (range: 1-93) were included in the study. In consecutive age groups, ML and GSL gradually increased and became steady between 16-19 & 20-30 age groups and 10-12 & 13-15 age groups, respectively. On the other hand, MGW gradually increased until 20 years of age and became steady at median of 35 mm over 20 years of age. Another interesting finding was a rather stable GSL/ML ratio in all age groups. Pairwise comparison of different age groups seemed to be similar and suggests a fixed ratio of 1.33 (IQR: 0.6). ConclusionThe normal glanular and meatal measurements may guide the surgeons for better cosmetic results during hypospadias repair. The GSL/ML ratio appears to be a stable measure for all ages to achieve better cosmetic results.

Age group differences in SFON tendency and arithmetical skills of four to seven year olds in four countries with different school starting ages

This study investigated age group differences in Spontaneous Focusing on Numerosity (SFON) tendency and arithmetical skills across age groups with differing starting ages of formal mathematics instruction. Children (N = 685) aged 4–7 years participated from four countries, i.e., Northern Ireland, England, Belgium and Finland, where children start formal school at 4, 5, 6, and 7 years respectively. Children completed measures of SFON tendency, Arabic number naming, verbal arithmetic and written arithmetic. Results revealed strong age group effects for all measures and some developmental differences between SFON tendency and arithmetical skills. Whether children were, or were not, in school had a strong effect on SFON tendency but not on arithmetical skills. In the 5 and 6 years old age group, children already in school had significantly lower SFON tendency compared to those not yet in school. Within each country, when comparing consecutive age groups situated near school starting age, SFON tendency scores were similar in three out of the four countries. Results suggest both informal and formal mathematical skills need to be considered when assessing young children’s mathematical competence.

Retzius-sparing robot-assisted radical prostatectomy in a medium size oncological center holds adequate oncological and functional outcomes

Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has emerged as a surgical option for patients with prostatic cancer in high-volume centers. The objective is to assess oncological and functional outcomes when implementing RS-RARP in a medium-volume center without previous experience of robotic surgery. This is a prospective observational single-center study. Patients operated between July 2017 and April 2020 were divided into two consecutive groups, A and B, each with 104 patients. The surgeons had prior experience in laparoscopic surgery and underwent robotic training. Positive surgical margin (PSM) status, urinary continence, and erectile function projected by Kaplan–Meier curves, together with patient reported quality of life outcomes at 12 months post-surgery were documented. Median patient age was 63 years (IQR = 59–67), overall PSM rate were 33%, 28% for pT2 disease. Pre-operative values showed no significant difference between both groups. The rate of urinary continence dropped from 81 to 78% (SE = 5.7) (Group A) and from 90 to 72% (SE = 6.3) (Group B) using the International Consultation on Incontinence Questionnaire-Short Form. Baseline sexual function was regained in 41% (Group A) and 47% (Group B) of patients. The median Expanded Prostate Index Composite-26 total score decreased from 86 to 82. These outcomes relate favorably to prior reports. There was a clinically significant decrease in median operative time in the successive groups with post-operative complications occurring in less than 2% of surgical procedures overall. A 12-month follow-up suggests that RS-RARP may be safely introduced in a medium-volume center without previous experience of robotic surgery.

Determining the prevalence of childhood hypertension and its concomitant metabolic abnormalities using data mining methods in the Northeastern region of Hungary.

Identifying hypertension in children and providing treatment for it have a marked impact on the patients' long-term cardiovascular outcomes. The global prevalence of childhood hypertension is increasing, yet its investigation has been rather sporadic in Eastern Europe. Therefore, our goal was to determine the prevalence of childhood hypertension and its concomitant metabolic abnormalities using data mining methods. We evaluated data from 3 to 18-year-old children who visited the University of Debrecen Clinical Center's hospital throughout a 15-year study period (n = 92,198; boys/girls: 48/52%). We identified a total of 3,687 children with hypertension (2,107 boys and 1,580 girls), with a 4% calculated prevalence of hypertension in the whole study population and a higher prevalence in boys (4.7%) as compared to girls (3.2%). Among boys we found an increasing prevalence in consecutive age groups in the study population, but among girls the highest prevalences are identified in the 12-15-year age group. Markedly higher BMI values were found in hypertensive children as compared to non-hypertensives in all age groups. Moreover, significantly higher total cholesterol (4.27 ± 0.95 vs. 4.17 ± 0.88 mmol/L), LDL-C (2.62 ± 0.79 vs. 2.44 ± 0.74 mmol/L) and triglyceride (1.2 (0.85-1.69) vs. 0.94 (0.7-1.33) mmol/L), and lower HDL-C (1.2 ± 0.3 vs. 1.42 ± 0.39 mmol/L) levels were found in hypertensive children. Furthermore, significantly higher serum uric acid levels were found in children with hypertension (299.2 ± 86.1 vs. 259.9 ± 73.3 μmol/L), while glucose levels did not differ significantly. Our data suggest that the calculated prevalence of childhood hypertension in our region is comparable to data from other European countries and is associated with early metabolic disturbances. Data mining is an effective method for identifying childhood hypertension and its metabolic consequences.

Relative age effect in young competitive tennis players

The purpose of this study was to examine the presence of the relative age effect (RAE) in young tennis players. Data from a sample of all ranked (n= 3463) and licensed (n= 29150) players in consecutive age groups (10- to 17-year-old) were collected from the official web page of the national federation. They were assigned to four quartiles according to the month of birth: a) Quartile 1 = January-February-March, b) Quartile 2 = April-May-June, c) Quartile 3 = July-August-September, d) Quartile 4 = October-November-December. The players aged between 10 and 17 years affiliated with the national federation were assigned as theoretically expected distribution. The results revealed that 70%, 60.1%, and 56.6% of the top 10, 50, and all ranked players were born in the first half of the year, respectively. However, the results from the chi-square test of goodness-of-fit showed significant RAEs only in the distributions of all ranked and top 50 players at the age of 10 and 11 correspondingly. These results may suggest that RAE exists among young tennis players who are in their early adolescence years.

The Effect of a Multifaceted Intervention Including Classroom Education and Bariatric Weight Suit Use on Medical Students’ Attitudes toward Patients with Obesity

Introduction: Weight bias refers to negative attitudes toward individuals because of their weight. Evidence-based strategies to successfully reduce weight bias in medical students are lacking. The purpose of this study was to investigate the impact of a multifaceted intervention on medical students’ attitudes toward patients with obesity. Methods: Third and fourth year medical students (n = 79), who enrolled in an 8-week graduate course focusing on the various epidemiologic, physiological, and clinical aspects of obesity, including a gamification task with bariatric weight suits (BWSs), were asked to complete the Nutrition, Exercise and Weight Management (NEW) Attitudes Scale questionnaire pre- and post-course. The inclusion period was between September 2018 and June 2021 and covered 4 consecutive groups of students. Results: The overall NEW Attitudes Scale scores did not change significantly pre- versus post-intervention (pre-course: 19.59, post-course: 24.21, p value = 0.24). However, the subgroup of 4th year medical students showed a significant improvement in their attitudes (pre-course: 16.4, post-course: 26.16, p value = 0.02). The Thurstone rating of 9 out of 31 individual survey items changed significantly from pre- to post-course with a moderate strength (Cramer’s V >0.2), including 5 items showing weight bias reduction. The disagreement with the statement “overweight/obese individuals lack willpower” increased from 37 to 68%. Conclusion: These findings suggest that in medical students with a low level of weight bias at baseline, a semester course on obesity combined with BWS use affects only a limited number of items of the NEW Attitudes Scale questionnaire. The sensitization of medical students to weight stigma has the potential to improve quality of healthcare for patients with obesity.

A prospective study of 93 unicompartmental knee prosthesis emphasises the appearance of radiolucencies under the tibial component

Here, we report the presence of radiolucent lines in a consecutive group of 93 partial knee replacements (UKA). The prospective study was conducted from 2011 to 2019 with a minimum follow-up of two years. Clinical data and radiographs were recorded. Of the 93 UKA, 65 were cemented. The Oxford Knee Score was recorded before and two years after surgery. In 75 cases, the follow-up was conducted at > 2 years. A lateral knee replacement was performed in 12 cases. In one case, a medial UKA with patellofemoral prosthesis was performed. In eight patients (8.6%), a radiolucent line (RLL) underneath the tibia component was observed. In four of these eight patients, RLLs were non-progressive, without clinical implications. In two cemented UKAs, RLLs were progressive and were revised with total knee arthroplasty. Early severe osteopenia of the tibia (zone 1 to 7) in the frontal view was observed in two cementless medial UKA cases. The demineralisation occurred spontaneously five months after surgery. We diagnosed two early deep infections, one of which was treated locally. RLLs were present in 8.6% of the patients. Even in severe cases of osteopenia, spontaneous recovery of RLLs is possible with cementless UKAs.

Aetiology of long bone chronic osteomyelitis: an analysis of the current situation in one region in Egypt

IntroductionChronic osteomyelitis (COM) is a devastating infection requiring a multidisciplinary approach, including radiology, microbiology, pathology, and orthopaedic surgery to treat. The present study analysed the bacterial profile causing chronic osteomyelitis and their antibiogram in our region.Patients and methodsThis prospective study was done on a consecutive group of patients who underwent surgical debridement for long bone COM. Three to six deep tissue samples were collected during the index debridement for microbiology and one sample for histopathology. Antimicrobial sensitivity testing used an automated bacterial identification system. Gram stain was used to identify the bacteria type from its size, shape, and arrangement of bacterial growth.ResultsIntra-operative deep tissue and bone specimens accurately identified causative bacteria in 84.8% of patients. Gram-ve bacilli (GNB) were the most common causative organisms in 51.6% of all growing samples (36.4% isolated G-ve and 15.2% mixed with G + ve). Thirty-three patients (30 males/three females) were included; the mean age at index debridement surgery was 37.1 years. Half of the cohort had no metalwork. The aetiology of COM was post-operative infection in half of the patients.ConclusionThere may be concerning features in our patients’ aetiologies and causative organisms; closed fractures turn into COM postoperatively, several unsuccessful attempts, delayed index debridement, and more GNB. Plans need to be applied to break the cycle and improve outcomes.

Comparing People’s Experience of Therapy for Complex Trauma Across Three Modalities: Face-to-Face, Mixed, and Online

To compare client response to a 3-stage phased intervention for complex trauma, comparing (1) those who received face-to-face intervention with (2) those who received a hybrid of face-to-face moving mid-therapy to online intervention with (3) those who received online only. Comparing quantitative and qualitative outcome data from 3 consecutive groups (N=22) who participated in a 3-stage phased intervention for complex trauma (1) face-to-face intervention (n=7); (2) a mix of face-to-face and online intervention (n=6); (3) online only (n=9). Analysis of quantitative data indicated a reduction in trauma symptoms across all modes of delivery. Reliable change indices suggested that face-to-face intervention facilitated the greatest change. In response to questions, participants spoke about (1) having a positive experience of the intervention, (2) advice to future group members, (3) constructive feedback, and (4) the experience of engaging online. Responses indicated that the experience of all groups were broadly similar. Participants reported strong group connections and an increased understanding of trauma. Minor differences, specific to the practicalities of each group, were found in the constructive feedback offered. Comments regarding the online experience highlighted the accessibility of the modality and indicated a sense of diminished group cohesion. Overall, participants reported a preference for face-to-face engagement. The majority of participants benefitted from the intervention regardless of modality. However, there is tentative evidence that the online format was the delivery mode associated with poorer-performing clients. In the future, online engagement and client preference should be considered carefully.

Pregnancy Outcomes in Double Stimulation versus Two Consecutive Mild Stimulations for IVF in Poor Ovarian Responders.

To compare pregnancy outcomes between double stimulation (DouStim) and two consecutive mild stimulations in poor ovarian responders, this study retrospectively analyzed 281 patients diagnosed as having poor ovarian response (POR) who underwent oocytes retrieval for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) from January 2018 to December 2020. They were divided into two groups: the DouStim group (n = 89) and the two consecutive mild stimulations group (n = 192). The results illustrated that there were no significant differences in the number of oocytes and 2PNs between the two groups. The number of frozen embryos [1 (0, 2) versus 1(0, 2)] was significantly lower and the proportion of patients without frozen embryos (39.3% versus 26.0%) was significantly higher in the DouStim group than in the two consecutive mild stimulations group (p < 0.05). There were no significant differences in the clinical pregnancy rate (CPR) and the cumulative live birth rate (CLBR) between the two groups (p > 0.05). The intra-subgroup comparison showed that in young POR patients under 35 years old, there were no significant differences in clinical indicators and pregnancy outcomes (p > 0.05). In elderly POR patients aged 35 years and above, the number of frozen embryos [1 (0, 1.5) versus 1 (0.25, 2)] (p < 0.01) was significantly lower in the DouStim group than in the two consecutive mild stimulations group, but the pregnancy outcomes were not significantly different (p > 0.05). In conclusion, the DouStim protocol is inferior to the two consecutive mild stimulations protocol in terms of the number of frozen embryos, which mainly occurs in elderly patients, but there is no difference in pregnancy outcomes between the two protocols.

Axonal loss at time of diagnosis as biomarker for long-term disability in chronic inflammatory demyelinating polyneuropathy.

We hypothesized that early, pretreatment axonal loss would predict long-term disability, supported by a pilot study of selected patients with chronic inflammatory demyelinating polyneuropathy (CIDP). To further test this hypothesis, we examined a larger consecutive group of CIDP patients. Needle electromyography and motor and sensory nerve conduction studies were carried out in 30 CIDP patients at pretreatment and follow-up 5 to 28 years later. Changes in amplitudes were expressed as axonal Z scores and changes in conduction as demyelination Z scores and correlated with findings of the Inflammatory Rasch-built Overall Disability Scale (I-RODS), the Neuropathy Impairment Score (NIS), and isokinetic dynamometry (IKS). At follow-up, the median I-RODS score was 73, the NIS was 23, and the IKS was 56%. The median axonal Z score was unchanged at follow-up. Conversely, the corresponding demyelination Z scores improved. The initial axonal loss was correlated with the clinical outcome and was an independent predictor of outcome by multivariate regression analysis. Axonal loss at follow-up was also correlated with the clinical outcome. Only the follow-up demyelination Z score was correlated with the clinical outcomes. Furthermore, the latency until treatment initiation was predictive of all three clinical outcome scores at follow-up, and of axonal loss and demyelination at follow-up. The present study findings indicate that pretreatment axonal loss at diagnosis in CIDP is predictive of long-term disability, neurological impairment, and strength. A delay in treatment is associated with more pronounced axonal loss and a worse clinical outcome.

Effects of Age and Sex on Aerobic Fitness, Sprint Performance, and Change of Direction Speed in High School Athletes.

Hackett, DA, He, W, Fleeton, JRM, Orr, R, and Sanders, RH. Effects of age and sex on aerobic fitness, sprint performance, and change of direction speed in high school athletes. J Strength Cond Res 37(5): 325-331, 2023-The purpose of this study was to examine the effects of sex and age on aerobic fitness, sprinting performance, and change of direction speed (CODS) in high school athletes, with consideration for maturity. This cross-sectional study involved 2,132 adolescents (1,415 male and 717 female athletes) aged 12.0-15.9 years. Assessment of aerobic fitness using the 20-m multistage fitness test (20MSFT) and 20-m sprint and CODS using the 505 test was performed. For the analysis of data, subjects were separated into 4 age groups: U/13 years, U/14 years, U/15 years, and U/16 years. Estimated age at peak height velocity was a covariate in the data analysis to control for maturity status. Compared with female athletes, male athletes had superior performances at all age groups in 10-m sprint ( p < 0.001, effect size [ES] = >-0.44), 20-m sprint ( p < 0.001, ES = >-0.55), and 505 test ( p < 0.001, ES = >-0.41). Female athletes performed better than male athletes in 20MSFT at U/13 ( p < 0.01, ES = -0.22); however, male athletes had better performances at U/15 ( p < 0.01, ES = 0.27) and U/16 ( p < 0.001, ES = 0.67). At each consecutive age group, male athletes improve their performances in 20MSFT and sprints and at U/14 and U/16 in the 505 test ( p < 0.001, ES > -0.37). Female athletes showed no improvement in the 20MSFT and 505 test between U/13-U/16 but showed improved sprint performance at U/15 compared with U/13 and at U/16 compared with U/14 ( p < 0.05). This study shows that adolescent male athletes perform consistently better than female athletes in running-related field-based tests and display continuous improvements across age groups.

Balancing Clinician Workload Through Strategic Patient Panel Designs.

Clinician workload is a key contributor to burnout and well-being as well as overtime and staff shortages, particularly in the primary care setting. Appointment volume is primarily driven by the size of patient panels assigned to clinicians. Thus, finding the most appropriate panel size for each clinician is essential to optimization of patient care. One year of appointment and panel data from the Department of Family Medicine were used to model the optimal panel size. The data consisted of 82 881 patients and 105 clinicians. This optimization-based modeling approach determines the panel size that maximizes clinician capacity while distributing heterogeneous appointment types among clinician groups with respect to their panel management time (PMT), which is the percent of clinic work. The differences between consecutive PMT physician groups in total annual appointment volumes per clinician for the current practice range from 176 to 348. The optimization-based approach for the same PMT physician group results in having a range from 211 to 232 appointments, a relative reduction in variability of 88%. Similar workload balance gains are also observed for advanced practice clinicians and resident groups. These results show that the proposed approach significantly improves both patient and appointment workloads distributed among clinician groups. Appropriate panel size has valuable implications for clinician well-being, patients' timely access to care, clinic and health system productivity, and the quality of care delivered. Results demonstrate substantial improvements with respect to balancing appointment workload across clinician types through strategic use of an optimization-based approach.

MRI Findings in Patients with Discordant Results Between Gravity Test and Weight-Bearing Stress Views in Isolated Supination-External Rotation Fibular Fracture

Category: Trauma Introduction/Purpose: Medial and syndesmotic stability evaluation of isolated supination-external rotation fibula fractures (ISER) is critical to determine surgical conduct. However, there is no agreement on the best method to diagnose instability preoperatively. This problem is especially relevant in those with less than 2mm displacement in non-weightbearing radiographs. Different radiographic stress methods have been proposed: external rotation, weightbearing x-rays (WBx), and gravity stress radiographs (GSx). Likewise, the literature describes the use of ultrasound and magnetic resonance imaging (MRI) as complementary studies. To our knowledge, no studies have described the MRI findings in patients with discordant results between GSx and WBx views. Purpose: To analyze the imaging findings in WBx, GSx, and MRI in a consecutive group of patients with ISER with discordant results on stress views. Methods: For two years and prospectively, consecutive patients treated in a Level 1 trauma center were enrolled, performing the following imaging study protocol:- All patients with ISER fractures with a congruent tibiotalar joint on non-weightbearing radiographs underwent a bilateral WBx and GSx.- When there was a discordant result between WBx and GSx, MRI was taken. A retrospective analysis of the patients who had a complete study was carried out, considering the radiological findings and measurements. Measurements on radiographs were performed by six physicians (2 general practitioners, two trauma residents, and two ankle and foot subspecialists). One musculoskeletal radiologist analyzed the MRIs. The following parameters were measured, medial clear space (MCS), superior clear space (SCS), and tibiofibular clear space (TFCS). Inter-observer agreement in radiographs was analyzed using the intra-class correlation coefficient. Differences between groups were evaluated by t-student for independent samples, considering α &lt;=5% significant. Results: Thirty-four patients were recruited. Interobserver agreement was good to excellent on all radiographic measurements. For all the measurements in the WBx, there were no significant differences between the injured and the healthy side. Average of MCS 2.51, SCS 3.07 and TFCS 3.74 mm for the uninjured side; and MCS 2.51, SCS 3.12, and TFCS 3.67 mm for the injured side. In the GSx, significant differences were observed for all measurements between the fractured and the healthy side. Average of MCS 3.55, SCS 3.85, and TFCS 3.89 for the healthy side; and MCS 5.87, SCS 4.25, and TFCS 4.44 for the injured side.100% of GSx and 0% of WBx met instability criteria (more than 2 mm compared to the healthy side). None of the MRIs showed a complete lesion of the deep deltoid ligament nor syndesmal complex. Conclusion: MRI did not demonstrate a complete deltoid nor syndesmal lesion in any patient with ISER fracture with normal WBx and altered GSx. A positive GSx does not correlate with MRI findings in patients with a non-displaced WBx study.

273. EVALUATION OF THE RESULTS OF ‘TUBELESS’ ESOPHAGECTOMY IN PATIENTS WITH ESOPHAGEAL CANCER WITHIN AN ERAS PROTOCOL

Abstract Classically, esophagectomy used to routinely left chest drains, as well as decompressive nasogastric tube (NGT) and feeding jejunostomy, making the postoperative period slower and more uncomfortable for patients. Our objective is to evaluate the results of not using tubes and drains (tubeless esophagectomy) in patients with esophageal cancer undergoing McKeown esophagectomy within an ERAS protocol in our center. Retrospective, descriptive and comparative study of two consecutive groups undergoing McKeown esophagectomy. The first group (P) included 25 patients with tubes and drains (April 2018–August 2019) and the second group (T) 25 patients undergoing tubeless esophagectomy (July 2020–December 2021). In group P all patients were left with thoracic drainage and jejunostomy and in selected cases abdominal drainage; no patient was left with NGT. In group T (‘TUBELESS’) no drains or NGT were placed. No jejunostomy was performed except in those patients at high risk of malnutrition, and a phantom jejunostomy was used instead. Both study groups are comparable in terms of epidemiological characteristics, etiology, preoperative tumor stage and neoadjuvant treatment. In group P, 86% of the patients underwent or already had a jejunostomy, 100% of the patients were left with a left thoracic drain and 28% with an abdominal drain. None of the patients had a cervical drain or NGT. In group T no cervical, abdominal or thoracic drain was placed, but 2 patients (8%) underwent a jejunostomy due to high risk of malnutrition. Table 1 shows the postoperative results. There are no significant differences in 90-day mortality, readmission rate or anastomotic leakage. Despite the widespread thought of the need for the use of chest drains after esophagectomy, abstention from their use, as well as abstention from the use of decompressive nasogastric tube and feeding jejunostomy (replacing it with the use of a ghost jejunostomy), does not increase morbimortality and improves the postoperative comfort of the patient, as well as the hospital stay.

No correlation between performance tests, clinical measurements and data from patient-reported outcome measures (PROM) in children reconstructed for anterior cruciate ligament injury.

To investigate if patient-reported outcome measures (PROMs), functional tests and clinical measures correlate well in children after reconstruction of the anterior cruciate ligament (ACL). It was hypothesized that these outcomes correlate, so it is sufficient to report only one of them. A consecutive group of children (< 16years old) who had an ACL reconstruction, were prospectively followed and assessed after 1-year with Pedi-IKDC and KOOS-Child, instrumented laxity measurement, range of motion, extension strength and four performance tests. Relations between the different outcomes were calculated by partial correlation coefficient analysis, controlling for gender, age, height, and weight. Outcomes were available for 141 of 163 children. There were only few positive and weak correlations between performance tests and PROM scores and between clinical measurements and PROM scores. There were weak to strong correlations between the scores from Pedi-IKDC and the scores from each of the five domains of KOOS-Child and a weak to moderate correlation between the different domains of KOOS-Child. Similar correlations were found between the different performance tests. For children who had their ACL reconstructed there was no clinically important correlation between scores obtained by PROMs, a battery of functional performance tests and instrumented laxity of the knee at 1-year follow-up. This is an argument for always to include and report all three types of outcomes. Level II.

Does the technique of limb lengthening affect physeal growth in patient with achondroplasia? Comparison of the simultaneous and consecutive tibia and femur lengthening with external fixators.

We aimed to retrospectively investigate and compare patients who underwent bilateral simultaneous and consecutive lengthening surgery of the femur and tibia in terms of the effect on physeal growth. We hypothesize that compared with the sequential lengthening technique, simultaneous lengthening of the bilateral femur and tibia affects physeal growth to a greater extent. Twenty-six patients with achondroplasia who operated in our clinic between 1995 and 2015 for limb lengthening were included in the study. Fourteen patients with bilateral lengthening of the femur and tibia at the same time were named as simultaneous bilateral lengthening (SBL). Twelve patients with bilateral lengthening of the femur and then bilateral tibia lengthening in other sections or vice versa, at a different time was named consecutive bilateral lengthening (CBL). All patients were followed until at least 18 years old. The physeal arrest was measured with predicted final length at the first visit (investigated with the multiplier method), the total amount of lengthening, and final clinical, and radiological length. Mean limb lengthening was 145 mm (48.5%) and 151 mm (46.6%) for simultaneous and consecutive groups respectively. For lower extremity length, the first group reached 527.6 mm while the expected was 447.3 mm. Considering 151 mm lengthening, the mean growth disturbance for the SBL group was 70.7 mm and for the CBL group was 47.5 mm. For total height comparing between two groups, disturbance for height was 80.5 mm and 65.4 mm, respectively. Although there was no statistical difference, simultaneous bilateral femoral and tibial lengthening has more physiological physeal disturbance effects than consecutive lengthening in patients with achondroplasia.

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve.

Surgeons considering transitioning to an anterior-based approach for THA are concerned about the learning curve and the reported marginal clinical benefit. Accordingly, the first cohort of THAs, which were implanted by a single surgeon using the anterior-based muscle-sparing approach (ABMS), was analyzed. The goal of the study was to test 1) whether patient-reported outcomes improved and 2) whether the complication rate decreased with the number of THAs performed. A retrospective cohort study on the first 30 primary THA cases (27 patients) of one surgeon (January 2021-April 2021) using the ABMS approach was conducted. These 30 THAs were compared to 30 primary THA cases (30 patients) done immediately prior to the transition by the same surgeon (September 2020-December 2020) using the posterior approach (PA). The Oxford Hip Score (OHS), Hip Disability and Osteoarthritis Outcome Score (HOOS Junior), and Forgotten Joint Score (FJS) obtained 6 weeks and 6 months after surgery were compared. In addition, three consecutive groups based on equal numbers of THAs were compared for the incidence of complications and surgery time. At 6 weeks after THA, the OHS was 6 points higher after the ABMS approach (p = 0.0408), and the OHS was comparable at 6 months. The HOOS Junior and FJS were similar at 6 weeks and 6 months after surgery.In the first 10 THAs using the ABMS approach, one patient had a greater trochanter fracture, and one patient had an intraoperative proximal femur fracture. No further immediate interoperative or postoperative complications occurred. Surgery time significantly reduced with the number of THAs performed. Transitioning from the PA to the ABMS approach is associated with a learning curve, which is limited to the first 20 cases. The effect of improved clinical outcomes is apparent within the early postoperative period. After 6 months, THA patients do well regardless of the approach.

European Prevalence of Polypoidal Choroidal Vasculopathy: A Systematic Review, Meta-Analysis, and Forecasting Study.

The purpose of this study was to provide an estimate of the number of current and future patients with polypoidal choroidal vasculopathy (PCV) in Europe. We systematically searched 11 literature databases on 18 May 2022 for studies on the prevalence of PCV among a consecutive and representative group of patients with suspected neovascular age-related macular degeneration (AMD). Prevalence of PCV in patients with suspected neovascular AMD was summarized and included in a prevalence meta-analysis. We then used current population data and population forecasts by Eurostat and the Office for National Statistics to determine current and future number of patients with neovascular AMD in Europe. Then, we calculated the number of patients with PCV with our calculated estimate of the prevalence of PCV among Europeans suspected with neovascular AMD. A total of five eligible studies were identified which included a total of 1359 patients. All these studies used the gold standard of indocyanine green angiography as a routine part of their diagnostic approach. Among patients undergoing detailed retinal examination for suspected neovascular AMD, our meta-analysis calculated the prevalence of PCV to be 8.3% (95% confidence interval: 6.8–9.8%). Our population estimates find that a total of 217,404 patients with PCV exist in Europe in the year 2022, which constitutes 0.04% of the entire population of Europe. This number is estimated to increase to 287,517 patients in the year 2040. Our estimates are important for different healthcare stakeholders, especially when planning and allocating expensive resources.