Level Of Evidence Research Articles

Current Evidence and Advances in CAD-CAM Resin Composite Blocks for Chairside Dental Restorations: Where Are We Now? A Scoping Review

Objective: This study aimed to determine the status of the scientific literature on CAD-CAM resin blocks by mapping the available evidence and identifying knowledge gaps. Data/Source: A systematic search of studies investigating CAD-CAM resin blocks was conducted. Risk of bias was assessed, and data on study designs, level of evidence, compositional classification, manufacturer, commercial brand, and properties investigated were extracted. This review followed Arksey and O’Malley’s five-stage framework and utilized Medline (OVID), EMBASE, and Scopus (Elsevier) databases. Study Selection: Study selection resulted in 27 studies for data extraction out of 209 studies screened from an initial pool of 529 studies. High sampling bias related to sample size and randomization was observed in almost all studies. Most studies (99%) were conducted in vitro, with low levels of evidence. The most common composition was “nano-ceramic”. 3M ESPE was the manufacturer with the most investigated blocks, and their product, 3M™ Lava™ Ultimate Restorative, was predominant in the selected investigations. Methodological heterogeneity was extensive among the studies, with mechanical properties (38%) and bond strength (35%) being the most commonly investigated outcomes. Conclusion: This scoping review indicates an increasing trend in dental research assessing CAD-CAM resin blocks. However, the overall level of evidence derived from these studies is low, predominantly consisting of in vitro investigations. Clinical Significance: The findings underscore the need for clinical trials to augment the level of evidence and enable long-term assessment of CAD-CAM resin blocks. Dentists should be cautious while interpreting the findings from in vitro studies, as the outcomes may not directly translate to clinical success.

Early versus delayed laparoscopic cholecystectomy for gallbladder perforation

BACKGROUND Gallbladder perforation occurs in 2% to 11% of patients with acute cholecystitis, with associated mortality estimated to be at 12% to 42%. Because of its low incidence, the data on management remain sparse. There is a lack of evidence to suggest whether early or delayed cholecystectomy is superior in the treatment of perforated cholecystitis. We hypothesize that an early definitive operation is associated with decreased total hospital length of stay (THLOS). METHODS Using the National Surgical Quality Improvement Program database from the American College of Surgery, we identified patients who underwent laparoscopic cholecystectomy for gallbladder perforation on an urgent or emergent basis from 2012 to 2021. We divided them into those who underwent early (<2 days from the date of admission to the date of operation) and delayed cholecystectomy (≥2 days from the date of admission to the date of operation). Our primary outcome was the THLOS. We created multivariate regression models to assess for the association of early versus delayed operation and THLOS. RESULTS The THLOS was found to be 2.94 days longer in the delayed group compared with the early group (p < 0.05). In those who did not present with sepsis on admission, the THLOS was noted to be 4.71 days longer in the delayed group compared with the early group (p < 0.05). Early versus delayed operation was not associated with a difference in the postoperative length of stay, 30-day postoperative complications, rate of readmission, and reoperation, regardless of preoperative sepsis status. CONCLUSION Early laparoscopic cholecystectomy for gallbladder perforation is associated with decreased THLOS, and there were no other differences in outcomes compared with delayed laparoscopic cholecystectomy. Patients with gallbladder perforation would likely benefit from an early operation within 2 days of admission. LEVEL OF EVIDENCE Therapeutic/Care management; Level III.

Open abdomen versus primary closure in nontrauma patients: A weighted analysis of a single-center experience

INTRODUCTION The open abdomen (OA) technique is nowadays a worldwide strategy both for trauma and emergency general surgery. Despite the attempt at conducting prospective studies, a high level of evidence is far from established. The aim of this study was to investigate if we overused this strategy and if it improved the postoperative course of our patients. METHODS Emergency laparotomies from 2017 and 2023 were reviewed and stratified according to OA and closed abdomen (CA). Differences were balanced by inverse probability weighting, and the 90-day mortality was estimated. Subgroup analysis was carried out for patients with a Mannheim Peritonitis Index (MPI) of >26, bowel obstruction, bowel ischemia (BI) and gastrointestinal perforation. RESULTS Of the 320 patients, 167 were CA and 153 were OA. Groups were different for American Society of Anesthesiologists, comorbidities, transfusion rate, Physiologic and Operative Severity Score for the Study of Mortality and Morbidity score, MPI, Clinical Frailty Scale score, diagnosis, and resection. Two balanced pseudo-populations were created. The 90-day survival rate was 50.8% for CA and 60.8% for OA (hazard ratio [HR], 0.79; confidence interval [CI], 0.40–1.55; p = 0.502). At the Cox regression, the Clinical Frailty Scale score (HR, 1.125; 95% CI, 1.01–1.25; p = 0.033) and BI (HR, 5.531; 95% CI, 2.37–12.89; p < 0.001) were independent risk factors for mortality. Transfusion rate (odds ratio [OR], 3.44; 95% CI, 1.44–8.23; p < 0.006) and length of stay in the intensive care unit (OR, 1.13; 95% CI, 1.07–1.20; p < 0.001) were associated with major complications. Open abdomen did not modify mortality in the case of bowel obstruction, MPI >26, or gastrointestinal perforation. Finally, OA (HR, 0.056; 95% CI, 0.01–0.22; p = 0.001) and large bowel resection (HR, 6.442; 95% CI, 1.28–32.31; p = 0.040) were predictors of longer survival in the subgroup of patients with BI. CONCLUSION Open abdomen was not associated with a higher complication rate or higher mortality but did result in a longer in-hospital stay. The only setting where OA seemed to be advantageous was in the BI population. LEVEL OF EVIDENCE Epidemiological and Prognostic Study; Level III.

Comparative Study of Craniofacial Injuries in Skiing Versus Snowboarding: A NEISS Database Study

Introduction: Skiing and snowboarding are popular winter sports which are rising in popularity. There is a lack of detailed data in the literature regarding skiing and snowboarding head and neck injuries, especially the rate of concussions with helmet use. Methods: The authors queried the National Electronic Injury Surveillance System (NEISS) database to characterize patient demographics, injury types, subsite injured, and ED disposition associated with skiing and snowboarding-related head and neck injuries between 2009 and 2020 in the US. Results: An estimated 87,994 head and neck-related ski and snowboarding injuries were reported from 2011 to 2020 nationally. Ski-related and snowboard-related injuries comprised 51.9% and 48.1% of injuries, respectively. Ski-related injuries accounted for the majority of admissions (69.2%). Head injuries were the most common (68.3%), followed by injuries to the face (15.3%) and neck (12.2%). Concussions (57.7%) were the most common overall injury type and comprised 49.2% of admissions. Concussions were more common in snowboarding injuries (65.6% versus 50.3%, P<0.001), whereas lacerations (11.1% versus 14.4%), contusion/abrasions (6.7% versus 11.1%), and fractures (2.9% versus 7.0%) were more common in ski-related injuries. Cases with negative helmet status were associated with a greater proportion of concussion injuries (79.8% versus 70.9%, P<0.001). Conclusions: Patients presenting with skiing or snowboarding injuries require a thorough head and neck examination. A comprehensive history and physical should be performed with a focus on helmet use and evaluation for concussion, lacerations, and fractures. Helmet use is strongly recommended to prevent the risk of head injury. Level of Evidence: IV.

Changes in Physical Function After Long Corrective Fusion to the Ilium for Adult Spinal Deformity

Study Design. Prospective cohort study. Objective. To investigate longitudinal changes in physical functional status after long corrective fusion in patients with adult spinal deformity (ASD) during 2 years of follow-up. Summary of Background Data. In ASD surgery, reports assessing physical functional status in long-term observations for more than a year are lacking. Assessing whether patients maintain significant improvements in their physical status with a longer follow-up duration is crucial. Methods. A total of 70 female patients with ASD who underwent long corrective fusion of ≥ 7 segments between June 2016 and June 2022 were included in this study. Preoperative and postoperative assessments (at 6 months, 1 year, and 2 years) included radiographic spinopelvic parameters, health-related quality of life (HRQOL) using the Scoliosis Research Society Outcome Instrument-22 (SRS-22) questionnaire, and physical function tests conducted by a physical therapist. Results. All domains of the SRS-22 improved the most in the first 6 months after surgery (P <0.0001); however, the Pain and Function domains continued to improve gradually until 2 years postoperatively. Regarding trunk dynamic balance, the timed up-and-go test score improved gradually until 2 years postoperatively (P <0.0001). Regarding gait performance, gait speed and the 6-minute walking test improved the most in the first 6 months after surgery (P <0.01) and almost reached a plateau 1 year postoperatively. Conclusions. Long corrective fusion for ASD significantly enhanced physical function and HRQOL within 2 years, with the greatest improvement in the first 6 months after surgery. These findings underscore the importance of increasing activities of daily living through early exercise instruction, as well as preventive measures to avoid early surgery-related complications. Level of Evidence. 3

HPB SO47 - Adjuvant chemotherapy for early pancreatic cancer: Meta-analysis of survival benefit and the need for a national study of UK practice

Abstract Background Stage I pancreatic cancer is defined as disease localised to the pancreas (T1-T2, N0, M0). Whilst landmark trials have demonstrated adjuvant chemotherapy (AC) improves survival in resectable disease, early stages comprise only 3-8% of cases. The benefit of AC in stage 1 pancreatic cancer is yet to be defined and there currently exists no data outlining the use of AC for early disease in the United Kingdom (UK). We aimed to perform a meta-analysis evaluating comparative outcomes of pancreatic cancer resection with or without AC in patients with stage I pancreatic cancer and outline plans for a national collaborative study. Method A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted. All comparative studies reporting outcomes of pancreatic cancer resection for stage I cancer with or without AC were included and their risk of bias were assessed using ROBINS-I tool. Survival outcomes were analysed using hazard ratio (HR) and odds ratio (OR) for the time-to-event and dichotomous outcomes, respectively. Results We included six studies reporting 6,874 patients with resected stage 1 pancreatic cancer of whom 3,951 patients had no AC and the remaining 2,923 patients received AC. The use of AC was associated with significantly higher overall survival (HR 0.71, P<0.00001) and 2-year survival (65.1% versus 57.4%, OR 1.99, P=0.04) compared to no use of AC. There was no statistically significant difference in 1-year (86.8% versus 78.4%, OR 1.60, P =0.25), 3-year (46.0% versus 44.0%, OR 1.07; P =0.43), or 5-year survival (24.8% versus 23.3%, OR 1.03; P =0.81) between the two groups. Conclusion Meta-analysis of best available evidence (level 2a with low to moderate certainty) demonstrates that AC may confer survival benefits for stage I pancreatic cancer when compared to the use of surgery alone. National evaluation of the use of AC within the UK is currently lacking but is necessary. Randomized control trials are required to escalate the level of evidence and confirm these findings with consideration of contemporary chemotherapy agents and regimens.

Tumor seeding across specialties: a systematic review

BackgroundUnderstanding shared characteristics underlying reported tumor seeding episodes can reveal when tumor seeding is most likely to occur and guide clinical decision making. Our goal was to systematically review tumor seeding across specialties and determine what types of instrumentation and primary tumor histology are associated with tumor seeding.MethodsA systematic review was conducted using PubMed and Web of Science, per PRISMA guidelines. Publications ranged from 1965 to 2022, and studies with five or more reports of seeding were included. Papers were sorted by specialty and assigned a PRISMA Level of Evidence, and data analysis was conducted based on whether each paper supported the clinical significance of seeding.Results7,165 papers were screened with 156 papers included for analysis. Overall, there were 8,161 cases of tumors seeding across specialties with the majority from general surgery, gastroenterology, and urology. Laparoscopy (n=1,561) and needle biopsy (n=3,448) were most frequently implicated, and carcinomas (n=5,778) and adenocarcinomas (n=1,090) were the most common primary tumor types.DiscussionUpon review of the most updated (2023) versions of the NCCN and NICE guidelines across all cancer types, there were identified gaps in the coverage of tumor seeding within these guidelines, with tumor seeding being entirely absent from certain guidelines and partially absent from others.ConclusionsGiven the high cumulative reports of seeding and the deadly and disseminated nature of secondary disease, it is important to consider seeding risk when manipulating tumors and to modify current cancer care guidelines (NCCN/NICE) to ensure that they appropriately address seeding risk.

An exploration of undergraduate health science students’ experiences of blended learning andragogy: A rapid review

Introduction: Blended learning is defined as the combined use of in-person and online learning, through interactive multimedia and face-to-face engagement with curriculum content. Recently, higher education institutions have experienced major inevitable changes in teaching and learning approaches, sparking interest in the exploration of these approaches- including blended learning. Aim: To explore undergraduate health sciences students’ experiences of blended learning. Method: A rapid review of articles published in English was conducted between 18th-22nd February 2022 using the following databases: Pubmed, Ebscohost, Web of Science, Scopus, Africawide Information and CINAHL. Articles found were exported to Endnote, version 20.2.1. The Preferred Reporting Items for Systematic Reviews and Meta-analysis flow chart was used to document the search. The Critical Appraisal Skills Programme was used to appraise the articles, which were analysed using thematic analysis. Findings: Eight quantitative articles were analysed and categorised on the hierarchy of evidence. Three themes emerged: 1. Student engagement and perceptions of blended learning, 2. Student academic performance, and 3. Challenges of blended learning. Conclusion: Positive experiences of blended learning were reported, including: significant improvement of student academic performance, higher levels of satisfaction and an increased student engagement. Ineffective online learning platforms and/or technological devices resulted in students experiencing anxiety and frustration. Implications for practice Blended learning may be a feasible option to maintain and enhance students learning experience. Students’ academic performance could improve with blended learning Blended learning could increase students’ engagement within the andragogical field.

Pediatric Orthopaedic Surgeons Manage Pediatric Diaphyseal Clavicle Fractures Differently Than Nonpediatric Orthopaedic Specialists

Background: Pediatric clavicle fractures are often managed by physicians with and without pediatric subspecialty training. The aim of this study is to identify if variability of practice exists between pediatric orthopaedic surgeons versus nonpediatric orthopaedic specialists during management of pediatric diaphyseal clavicle fractures. Methods: Patients ≤18 years of age with an acute, closed diaphyseal clavicle fracture treated between January 2018 and July 2023 by a large hospital-employed multispecialty orthopaedic practice (in a regional and academic health network) were retrospectively reviewed. The study involved 26 orthopaedic surgeons (including 3 pediatric, 8 sports medicine, and 6 general) and 11 nonoperative sports medicine physicians, all of which accept patients ranging 0 to 18 years of age. Exclusion criteria included open or impending open fractures and insufficient data. Demographic, radiographic, and outpatient treatment parameters were recorded. Age groups were separated into <10 and ≥10 years old to control for age-associated differences. Results: Among 560 pediatric clavicle fractures, 385 met inclusion criteria (43.6% of which were treated by a pediatric orthopaedic surgeon), and 361 were treated nonoperatively. Follow-up averaged 48.8 days until orthopaedic discharge and 16.9 months until the most recent well-child visit (80% had a well-child visit after orthopaedic discharge). No patient <10 years of age had elective surgery, but pediatric orthopaedic surgeons demonstrated lower surgical rates in adolescent patients than nonpediatric specialties (4.3% vs. 14.4%, OR=3.8, P=0.027). Among the 169 nonoperative patients <10 years of age, pediatric orthopaedic surgeons completed fewer outpatient visits (2.1±0.8 vs. 2.4±0.8, P<0.037), shorter follow-up durations (28.5±18.9 vs. 41.8±22.6 d, P<0.001), less radiographic series (2.1±0.8 vs. 2.4±1.0, P<0.047), and less total radiographs (4.3±1.8 vs. 5.0±2.3, P<0.013) than nonpediatric specialists. Conclusions: The surgical rate of acute, closed diaphyseal clavicle fractures is lower among pediatric versus nonpediatric orthopaedic surgeons in adolescents. During nonoperative management of pediatric clavicle fractures, pediatric orthopaedic surgeons treat young patients (but not adolescents) with less outpatient visits and radiographs than nonpediatric orthopaedic physicians. Level of Evidence: Level III

Effect of Ketorolac Administration on the Rate of Nonunion of Operatively Treated Pediatric Long-Bone Fractures

Background: Nonunion is a rare yet serious complication in pediatric fracture healing that can lead to patient morbidity and economic burden. The administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with an increased risk of fracture nonunion in adults, but data are lacking in the pediatric population. This study examines the relationship between postoperative ketorolac administration and nonunion in operatively managed pediatric long-bone fractures. Methods: A retrospective cohort study was conducted with use of TriNetX, a research network that encompasses data from the United States, Canada, and Western Europe. A total of 462,260 patients from 52 health-care organizations met the inclusion criteria. Patients <18 years old with operatively managed upper or lower-extremity long-bone fractures were included. The exposure of interest was ketorolac administration within 30 days postoperatively between 2003 and 2023. Nonunion was identified and verified with use of the pertinent medical codes. Absolute risks and hazard ratios (HRs) were calculated for both study groups. Significance was set at p < 0.05. Results: After propensity score matching, 48,778 patients were identified per group. The incidence of nonunion was 2.19% in the ketorolac group and 0.93% in the non-ketorolac group (HR, 2.71; 95% confidence interval [CI]: 2.46, 3.21; p < 0.0001). Subgroup analyses demonstrated a higher risk of nonunion in patients with lower-extremity fractures (HR, 3.45; 95% CI: 3.14, 3.75; p < 0.0001) than in those with upper-extremity fractures (HR, 2.11; 95% CI: 1.84, 2.32; p < 0.0001). Among the fracture location subgroups, the greatest HR for nonunion was observed in patients with femoral fractures, followed sequentially by those with tibial and/or fibular fractures, humeral fractures, and radial and/or ulnar fractures. Conclusions: To our knowledge, this is the largest study to date to explore postoperative ketorolac use and nonunion in the setting of operatively managed pediatric long-bone fractures. Nonunion in children was rare, occurring in <1% of all included patients. Ketorolac administration was associated with a 2 to 3-fold increase in nonunion risks, with pronounced implications for patients with lower-extremity fractures, particularly those with femoral fractures. Clinicians should weigh the therapeutic advantages of non-opiate analgesia with ketorolac against the risk of nonunion in order to optimize postoperative pain management and recovery. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Tibial Malalignment is an Independent Predictor of Nonunion After Intramedullary Nailing of Tibial Shaft Fractures

OBJECTIVES: This study aimed to assess the relationship between postoperative alignment and nonunion in patients with tibial shaft fractures treated with intramedullary nailing. METHODS: Design: Retrospective case-control study. Setting: Single academic trauma center. Patients Selection Criteria: Adult patients with closed or open tibial shaft fractures (42A-C) treated with intramedullary nailing from 2007 to 2018. Outcomes Measures and Comparisons: Case patients with nonunion were compared to control patients with radiographic evidence of healing in terms of the postoperative tibial alignment measured in the coronal and sagittal planes. RESULTS: Of the 192 included patients (median age, 38 years; 76% male), 51 patients had a nonunion, and 141 patients had united fractures and served as the control group. A strong association between postoperative tibial malalignment in one plane and nonunion (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.1 to 8.3; P = 0.03) was demonstrated. This association was even greater for malalignment in both coronal and sagittal planes (OR, 5.7; 95% CI, 2.1 to 16.1; P < 0.001) after controlling for confounders. CONCLUSION: After controlling for confounding factors, postoperative malalignment in the coronal or sagittal plane was associated with significantly increased odds of tibial shaft nonunion after intramedullary nailing Level of Evidence: Therapeutic, Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison of Hand Function after Single-Digit Replantation in Elderly and Younger Patients

Background: With ageing of the population, there is an increasing likelihood that elderly people will seek employment, with a resultant increase in the incidence of hand injuries, including digital amputations. However, the surgical indication for replantation of an amputated digit in elderly patients is controversial. The purpose of this study was to compare functional outcomes after single-digit replantation of the thumb to long finger in older (≥65 years old) and younger (<65 years old) patients to assess the feasibility of digit replantation in the elderly population. Methods: A retrospective cohort study was performed in 25 patients (12 elderly and 13 younger) with successful replantation of the thumb, index or long finger at our hospital. All patients were followed up for more than 1 year. Key pinch strength, Semmes–Weinstein (S–W) test, % total active motion (TAM), Purdue Pegboard Test score (hand dexterity) and Disabilities of the Arm, Shoulder and Hand (DASH) score were investigated. Results: Elderly patients showed significantly worse results for the S–W test and Purdue Pegboard Test score. The % TAM, key-pinch strength and DASH scores were similar in the two groups. Conclusions: Replantation surgery in elderly patients results in similar postoperative hand function (finger mobility and pinch strength) and activities of daily living to those in younger patients. Level of Evidence: Level III (Therapeutic)

A Prospective, Randomized, Controlled Trial of Methylene Blue Injection for Costal Cartilage Harvest Postoperative Analgesia

Abstract Background In plastic surgery, costal cartilage is an excellent support material. However, postoperative pain from costal cartilage harvesting can impact patient recovery and satisfaction with the surgery. Recent reports have shown that methylene blue (MB) is an effective local analgesic in postoperative management. Objectives We aimed to evaluate the safety and effectiveness of MB for pain relief in patients undergoing costal cartilage harvesting. Methods A total of 106 patients undergoing costal cartilage harvesting surgery were selected from the plastic surgery department between December 2022 and March 2024. They were randomly divided into 2 groups: the MB group and the ropivacaine group, with 53 patients in each group. Pain levels were assessed with a numerical rating scale, the Insomnia Severity Index (ISI), arm elevation angle, and postoperative satisfaction scales at 1 day, 3 days, 5 days, 1 week, 1 month, and 3 months postoperatively. Results Patients receiving MB exhibited a significant decrease in pain scores from 5 days to 1 month of treatment compared to the ropivacaine group. Additionally, in the MB group there was an improvement in ISI scores from 5 days to 1 month compared to the ropivacaine group. Furthermore, during the 3-month follow-up, the MB group had significant increases in satisfaction scores compared to the control group. Arm elevation angle in the MB group was significantly higher compared to the ropivacaine group at 5 days, 1week, and 1month. No serious adverse events were reported, with only 2 patients experiencing an allergic rash. Conclusions Methylene blue demonstrated significant pain reduction with minimal adverse effects. Level of Evidence: 3 (Therapeutic)

Correlation between Woody Species and Environmental Variables in a Tropical Forest in Central Laos

The tropical forest biome serves as a significant focal point for conservation endeavors. However, understanding the variations in woody plant composition and the underlying driving factors remains limited. The vegetation gradient within Phou Khao Khouay (PKK) National Park in central Laos presents an intriguing environmental model for investigating these patterns. This study, conducted within PKK National Park, aims to classify woody plant communities of three different forest types: mixed deciduous forest (MDF), dry evergreen forest (DEF), and mixed coniferous forest (MCF), utilizing both the phytosociology approach and multivariate analysis. Data from 32 permanent plots (each measuring 50 m × 50 m) were analyzed, revealing 5,477 tree individuals with a diameter at breast height (DBH) ≥ 5 cm, representing 194 woody species from 64 families and 133 genera. The results indicate significant diversity at the family and genus levels, identifying four distinct plant communities and 44 indicator species based on Tichy and Chytry's phi coefficient method. Stability characterizes the MCF forest type, while the stands of DEF and MDF exhibit differentiation into three communities each. Notably, high heterogeneity in species composition and environmental conditions is evident, with elevation and soil nutrient levels (specifically total phosphorus and total potassium) emerging as primary influencers on species coexistence. The study also highlights correlations between woody plant species composition and topographic and soil variables. These findings underscore the importance of identifying microhabitats conducive to growing and conserving woody plant species within PKK National Park for future research and conservation efforts.

Percutaneous Screw Fixation for the Management of Delayed Unions in Pediatric Lateral Humeral Condylar Fractures

Background: The use of in situ screw fixation for the treatment of pediatric lateral humeral condyle (LCH) delayed unions has recently been reported. While attractive, the currently available literature consists of small retrospective studies with mixed results. As such, the present study aims to describe the outcome of a group of children with delayed unions of LCH fractures treated with in situ fixation using a single, percutaneously placed cannulated screw in compression. Methods: A retrospective review of all pediatric patients (below 18 y) with lateral condyle fractures of the humerus treated surgically for delayed union between 2013 and 2023 at a single, tertiary referral center was completed. Clinical and radiologic variables related to the initial injury and delayed union were abstracted from the medical record, as were surgical variables. Radiographs were evaluated for union postoperatively; time to union was determined by the senior authors. Descriptive statistics were used to summarize demographic and outcome variables. Results: A total of 12 consecutive patients met the inclusion criteria. The mean age at the time of initial injury was 5.6 years; subjects were followed for a mean of 3.0 years following initial presentation. All were treated with a single, percutaneously placed screw in compression at a mean of 10.5 months after the original injury. Radiographic union was achieved in 11 (91.7%) patients. At the latest follow-up, all patients were pain free and demonstrated a functional arc of motion without evidence of avascular necrosis. A total of 2 patients required revision for loss of fixation. In one patient, a persistent lucent line was observed, and 1 patient was found to have a cubitus valgus deformity, both of which were not clinically relevant. Conclusions: Our results suggest that with the use of proper technique (a 4.5 cannulated screw inserted through the metaphyseal portion of the lateral condyle fragment, engaging the most medial/distal aspect of the humeral shaft), radiographic union and clinical healing can be achieved in the majority of patients. Percutaneous screw fixation should be considered as an option for cases of noninfected pediatric lateral condyle delayed unions. Level of Evidence: Level IV—evidence therapeutic studies

NIMG-68. A COMPREHENSIVE REVIEW OF THE USE OF FMRI IN EVALUATING FUNCTIONAL CONNECTIVITY AND ACTIVATION IN DISORDERS OF CONSCIOUSNESS

Abstract PURPOSE Disorders of consciousness (DoC) like vegetative and minimally conscious states pose significant diagnostic and prognostic challenges, compounded by the inherent limitations in communicating with affected patients. We performed a scoping review of the literature to examine the application of functional magnetic resonance imaging (fMRI) to the assessment of functional connectivity (FC) and activation in DoC. METHODS We searched the MEDLINE/PubMed, Web of Science, and Embase databases between the years 2004 and 2024 for English-language studies involving fMRI and DoC in adult populations, adhering to PRISMA guidelines. Included studies were evaluated for study design, DoC subtype, fMRI subtype, cohort size, and FC and/or activation findings. RESULTS Our initial search identified 17,475 results, of which 82 studies were ultimately included with a total of 3917 patients. Only one of the included studies was a randomized controlled trial, 24 were prospective cohort studies, three were retrospective cohort studies, and 54 were observational in design. The majority of studies utilized resting-state fMRI (n=54, 65.9%), and the most commonly investigated disorders of consciousness were minimally conscious states (31.9%), vegetative states (14.4%), and unresponsive wakefulness syndromes (12.9%). Among studies with higher levels of evidence like prospective and retrospective studies, FC and activation findings were heterogeneous, with several studies reporting abnormal connectivity in the default mode and auditory networks. Activation responses among patients also varied, with some patients of the same DoC displaying expected activation patterns while others did not. Normal patterns of connectivity and activation were associated with improved prognosis in eight prospective studies and one retrospective study. CONCLUSIONS These findings underscore the complexity of using fMRI to evaluate consciousness in DoC patients. Though fMRI has the potential to identify residual cognitive function, the variability in responses also indicates the need for personalized approaches and further research to standardize fMRI protocols for this purpose.

EPID-03. BRAIN CANCER IN AFRICA: UNCOVERING THE HIDDEN EPIDEMIC THROUGH A SYSTEMATIC REVIEW

Abstract BACKGROUND Cancer poses a significant public health threat globally, leading to substantial morbidity. While malignancies were previously thought to predominantly affect high-income countries, numerous studies indicate an increasing burden on resource-limited nations. Brain cancer, in particular, can be devastating due to treatment challenges and high mortality rates. Africa, with its resource-limited countries, must establish proper healthcare infrastructure to reduce cancer incidence and enhance patient survival. Additionally, the scarcity of data in this area in Africa presents a challenge to effective management. This study aims to explore the available evidence on the epidemiology and etiology of brain cancer in resource-limited African countries, highlighting the growing burden and advocating for further research. MATERIALS AND METHODS We conducted a systematic review by searching PubMed and Scopus using a predefined approach. Additionally, we utilized the Global Cancer Observatory and Global Burden of Disease databases. Studies reporting on brain cancer epidemiology, etiology, and impact in Africa were included, with the level of evidence assessed according to Centre for Evidence-Based Medicine guidelines. RESULTS Brain cancer presents a significant healthcare challenge in many African developing nations due to poor survival rates, inadequate funding and resources for reporting, identification, and treatment, as well as limited comprehensive research. CONCLUSION This study underscores the urgent need to address brain cancer as a major public health crisis in Africa. Improved treatment options and access to screening are essential to mitigate the disease burden. Thus, substantial and comprehensive research on brain cancer within Africa is crucial for effective management and reducing associated morbidity and mortality.

MFIB 2.0: a major update of the database of protein complexes formed by mutual folding of the constituting protein chains

Abstract While the majority of proteins with available structures are able to fold independently and mediate interactions only after acquiring their folded state, a subset of the known protein complexes contains protein chains that are intrinsically disordered in isolation. The Mutual Folding Induced by Binding (MFIB) database collects and classifies protein complexes, wherein all constituent protein chains would be unstable/disordered in isolation but fold into a well-defined 3D complex structure upon binding. This phenomenon is often termed as cooperative folding and binding or mutual synergistic folding (MSF). Here we present a major update to the database: we collected and annotated hundreds of new protein complexes fulfilling the criteria of MSF, leading to an almost six-fold increase in the size of the database. Many novel features have also been introduced, such as clustering of the complexes based on structural similarity and domain types, assigning different evidence levels to each entry and adding the evidence coverage label that allowed us to include complexes of multi(sub)domain monomers with partial MSF. The MFIB 2.0 database is available at https://mfib.pbrg.hu.

Placental Extracts, Proteins, and Hydrolyzed Proteins as Active Ingredients in Cosmetic Preparations for Hair Loss: A Systematic Review of Available Clinical Evidence

Placentae and their derivatives have been used in both traditional and modern medicine, as well as in cosmetic sciences. Although hair loss is frequently mentioned among problems for which the placenta is supposed to be a remedy, the evidence seems rather scarce. The aim of this study was to highlight the clinical evidence for the efficacy of placenta products against baldness and hair loss. Methods: This systematic review was performed according to PRISMA and PICO guidelines. Database searches were conducted in PubMed, Google Scholar and Scopus. Results: Among the 2922 articles retrieved by the query, only 3 previously published clinical trials on placental products were identified. One study was a randomized controlled trial, in which the efficacy of a bovine placenta hair tonic was found to be comparable to that of minoxidil 2% in women with androgenic alopecia. Another controlled study showed that a porcine placenta extract significantly accelerated the regrowth of shaved hair in healthy people. The third study was an uncontrolled trial of a hair shampoo and tonic containing equine placental growth factor in women with postpartum telogen effluvium with unclear and difficult-to-interpret results. Due to the design and methodology of these studies, the level of evidence as assessed with the GRADE method was low for the first study and very low for the other two. Conclusions: The very limited scientific evidence available to date appears, overall, to indicate the efficacy of placental products in both inhibiting hair loss and stimulating hair growth. Unfortunately, the number of clinical studies published to date is very limited. Further, carefully designed, randomized controlled trials of well-defined placental products are needed to definitively address the question of the value of the placenta and its derivatives in hair loss.

The impact of surgical treatment of benign ovarian tumors on the reproductive health of women, taking into account the International Classification of Functioning

The article presents a systematic analysis of studies evaluating the impact of surgical treatment of benign ovarian tumors on reproductive health, taking into account the criteria stated by the International Classification of Functioning, Disability and Health. To identify articles, foreign and domestic scientific databases were used (PubMed, Cochrane, eLibrary). After the initial identification of 704 scientific publications, 46 articles were selected using inclusion and exclusion criteria.The conducted systemic analysis allows us to formulate the conclusion that surgical interventions performed for benign ovarian tumors contribute to damage to ovarian tissue, and as a result, a decrease in the ovarian reserve of patients, which is associated with impaired fertility. A number of authors have demonstrated some recovery of anti-Mullerian hormone (AMH) levels 3-12 months after surgery. A significant portion of the studies have demonstrated a more pronounced postoperative decrease in AMH rates in patients with endometriomas compared with women operated on for non-endometrioid ovarian tumors. Lower AMH rates were noted in women with bilateral surgeries for bilateral ovarian tumors compared to patients who had unilateral surgeries. The performed systemic analysis showed higher postoperative AMH rates in patients with intraoperative suture hemostasis in comparison with the use of bipolar energy; in addition, there is a relationship between the number of coagulations and the severity of the decrease in AMH rates. In a few studies, it was noted that patients who underwent surgical treatment of ovarian tumors experienced an earlier onset of menopause. In connection with these possible functional disorders, further clinical studies of a high level of evidence are needed, aimed at developing effective strategies for preserving the functioning of the reproductive system after surgical treatment of benign ovarian tumors.