Level Of Evidence Research Articles

Use of non-specific immunoglobulins in Catalonia in three third-level hospitals: a descriptive analysis of a hospital-prescribed medication registry

BackgroundThe increasing use of non-specific immunoglobulins (NSIGs) and their current shortage show a need for NSIGs’ use prioritization. Data from a clinical perspective are necessary, mainly for pediatric patients.ObjectivesThe aim of the study was to assess the level of clinical evidence (LoE) of the indications that NSIGs are used for, the reasons for discontinuation, and the costs invested.MethodsA retrospective multicentric study was conducted on NSIG incident users between September 2019 and December 2021 retrieved from the Registry of Patients and Treatments (RPT) from Catalonia (Spain). LoE was categorized as A) authorized indications, B) unauthorized with scientific support, C) unauthorized without support, and D) unknown (UNK), following local and the United Kingdom’s guidelines as a sensitivity analysis. We also estimated overall spending and costs per patient visit.ResultsA total of 400 patients were included (17.3% pediatric), with a mean follow-up of 122.1/person-years for adults. The most frequent indications were nervous system and blood diseases. Almost all pediatric patients (56; 81.2%) were treated under A-level indications, as for 217 (65.6%) adults. In the sensitivity analysis, the A-level usage rate decreased to one-third and the B-level usage rate increased by 2–3 times. Furthermore, 37.8% (151) of individuals discontinued. This was predominantly due to remission or no response. The total costs were 868,462.6€/year, with median spending per visit amounting to 1,500€ for adults and 700€ for pediatric patients.ConclusionNSIGs are used in clinical practice mainly for approved indications; however, non-approved indications are still an important issue. This could represent a significant economic burden on the healthcare system, focusing on the pediatric population and those at risk for discontinuation with alternative therapeutic options.

Therapeutical Strategies to Prevent Abdominoplasty Complications: A Systematic Review.

Abdominoplasty is one of the most commonly performed procedures. Despite improvements in the abdominoplasty technique, seroma is the most common complication, ranging from 5 to 43%. This study aimed to review the literature to compare therapeutic strategies to prevent common adverse events in abdominoplasty. This review analyzed patients of both sexes older than 18years who underwent abdominoplasty with or without liposuction. This study analyzed the following endpoints: frequency of seromas, surgical site infection, hematoma, dehiscence, necrosis, death, treatment duration for adverse events, length of hospital stay, seroma/hematoma volume. We analyzed 24 articles, totaling 2997 participants with ages ranging from 18 to85 years. The meta-analysis of 4 studies, with 180 participants, showed a 69% reduction in the occurrence of seroma when Scarpa's fascia preservation was adopted (OR, 0.38; 95%CI 0.16-0.91). Regarding other complications, Scarpa's fascia preservation showed a lower risk of infection (OR 0.31; 95%CI 0.12-0.79) and also lower risk of hematoma (OR 0.29; 95% CI 0.09-0.95) in seroma for Scarpa's fascia preservation when compared to not fascia's preservation. This review suggests that Scarpa fascia preservation decreases seromas, infections, and hematomas. However, more randomized controlled trials are necessary to improve the level of certainty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Methodological Quality and Content of Guidelines on Early Childhood Allergy Prevention: A Systematic Assessment and Content Analysis.

Recommendations on Early Childhood Allergy Prevention (ECAP) are found in Clinical Practice Guidelines (CPG) and Food-Based Dietary Guidelines (FBDG). This synthesis of guidelines aims to compare the methodological quality and content of recommendations in CPGs and FBDGs for ECAP. We searched MEDLINE, the FAO directory of FBDGs and other guideline databases, including the Association of the Scientific Medical Societies in Germany (AWMF), the WHO and the Guideline International Networks database on clinical guidelines (GIN) for CPGs and FBDGs about ECAP and child nutrition. Guidelines had to be published from 2010 onwards, target infants or pregnant/breastfeeding women and contain recommendations on primary preventative interventions to decrease the onset of IgE-mediated allergies, including atopic eczema or asthma. We retrieved a sample of 36 guidelines (23 CPGs, 13 FBDGs) and assessed their methodological quality with the Appraisal of Guidelines for Research and Evaluation tool (AGREE) II. On a subset of recommendations, we performed an in-depth analysis by the type of intervention for direction and strength of recommendation and level of evidence. Descriptive analysis was conducted with SPSS 27. CPGs score higher than FBDGs in most AGREE domains (3, 4, 5 and 6). The 36 guidelines contain 287 recommendations on ECAP, with 70 addressing the introduction of complementary foods and common allergens. We found only slight differences between those recommendations in CPGs and FBDGs. FBDGs on ECAP are of lower quality than CPGs. This does not affect their recommendations on the introduction of complementary foods and common allergens but may compromise their trustworthiness.

Pulmonary rehabilitation in connective tissue disease-associated interstitial lung disease: A systematic review.

Interstitial lung disease (ILD) is the major contributor to mortality in between chronic lung diseases. ILD originates from voluminous pathophysiological factors. One of the reasons is connective tissue diseases (CTD). According to experts, patients with CTD-ILD may have a stable disease activity and not need conventional treatment. Also, with pulmonary rehabilitation (PR), these patients may benefit from improving clinical outcomes and regression in mortality. However, the characteristics of these patients and whether they have stable disease activity in practice are not known. The systematic review was performed via the AI-powered tool with six databases to conduct literature research. The methodologic quality of the studies, risk of bias, and level of evidence were assessed. According to the final four included studies PR benefitmoderatelevels of evidence for lung functions and diffusion capacity, functional capacity, quality of life, dyspnea severity, and fatigue level. However, there was limited evidence for respiratory, and peripheral muscle strength for CTD-ILD patients. The literature shows that the use of PR for CTD-ILDs wasn't widespread. Our findings suggest that PR can be used in CTD-ILDs to recover clinical parameters like, lung functions, quality of life, dyspnea severity, and fatigue level. More comprehensive studies should be conducted to reveal the effect of the PR in the evidence-based frame.

Оценка результатов хирургического лечения детей с деформацией позвоночника и грудной клетки с применением навигационной установки

Idiopathic scoliosis (IS) accounts for 2% to 5% of cases in orthopedic pathology. Surgical treatment of severe, rigid IS forms remains an important and pressing problem. The purpose of this research was to evaluate the efficacy and safety of the surgical correction method of severe kyphoscoliotic deformity of the thoracic spine in children with the use of the active optical three-dimensional computer navigation technology. Materials and methods used: a retrospective, single-center cohort study of the surgical treatment results of 30 children aged 14 to 18 y/o with grade 4 IS was conducted with V (C) Level of Evidence. The inclusion criteria were as follows: the scoliotic deformity magnitude of over 80°, simultaneous discopphysectomy, mobilizing dorsal osteotomies and deformity correction with a multi-support metal structure. Results: the scoliosis magnitude in the preoperative period was 100.5° (min 82; max 130; SD=13.21), after surgery 27° (min 4; max 47; SD=12.53). Pairwise comparison demonstrated statistically significant differences (p=0.013). The kyphosis magnitude in the preoperative period was 39.4° (min 3; max 61; SD=16.61), after surgery - 37.7° (min 3; max 49; SD=6.59). The abovementioned data comparison demonstrated the absence of statistically significant differences (p=0.154). The vertebral rotation magnitude in the preoperative period was 35.5° (min 20; max 60; SD=8.73), after surgery - 20° (min 9; max 32; SD=6.54). When comparing the results, statistically significant differences were revealed (p=0.010). Neurological disorders after the surgical interventions were not noted in patients included in the study. Conclusion: the use of the method of surgical correction of severe kyphoscoliotic deformity of the spine from a combined approach using active optical three-dimensional computer navigation technology allows the complete correction of the spinal deformity, indirectly improving both the shape and the size of the chest and restoring the frontal and sagittal profiles of the spine.

Partial Cutting Otoplasty: A Stable Technique for Prominent Ears.

Prominent ears are a common deformity that can cause significant social and psychological distress, especially at a young age. Otoplasty changes the shape and, in some cases, the size of the ear, by working on two crucial points of the anatomy: the hypertrophy of the conchal bowl and the undeveloped antihelix fold. Generally speaking, there are two main approaches to auriculoplasty: cartilage cutting and cartilage sparing techniques; cartilage sparing techniques are safer but with limited aesthetic results. Despite the simplicity of this surgery, complications such as irreversible distortion of the anatomy, overcorrection, or recurrence are very frequent and have important consequences for facial aesthetics. A novel technique based on the perfect equilibrium between cartilage sparing and cartilage cutting technique is described. This method is based on three to four mattress sutures that reshape the antihelix, with a limited component of cartilage cutting and excision of the overdeveloped concha, avoiding high-tension sutures and scarring on the anterior surface of the ear. This technique was used on 150 ears from 2019 to 2023, with only three ears (2%) requiring revision. Rates of complications or recurrence were low. The presented technique appears to be a rapid, reproducible, and safe method for treating the prominent ear deformity, providing aesthetically pleasing results. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Utilizing Auricular Composite Grafts for Reconstruction of Nasal Ala Defects in Fitzpatrick Type III-V Indian Noses: Techniques and Outcomes.

Nasal ala defects present significant reconstructive challenges due to their complex anatomy and functional importance. Auricular composite grafts, incorporating both skin and cartilage, are particularly suited for this purpose because they can replace the multilayered structure of the nasal ala in a single surgical procedure, thereby restoring both form and function. Clinical outcomes of these grafts in the reconstruction of ala defects have been highly promising with studies indicating near complete survival rates. These findings underscore the efficacy of composite grafts in achieving successful results in these small but difficult defects to manage. The primary objective of this study is to assess the use of composite graft in Fitzpatrick type III-V Indian noses from survival and esthetic point of view. A retrospective review was conducted on eleven patients who underwent nasal ala reconstruction using auricular composite grafts between 2012 and 2022. Data collected included patient demographics, defect etiology and characteristics, surgical technique, postoperative outcomes and complications and follow-up duration. A total of eleven patients, age ranged from 17 to 68years, were included in the study. The majority of defects (seven) were acquired and resulted from trauma, ring avulsion and tumor excision and four were congenital clefts of ala. Graft survival rate was more than 90% with a follow-up period of 6months to 2years. Out of eleven grafts, one shrank approximately to half. No other complication was noted. Rest ten graft survived well with minimal shrinkage and produced esthetically pleasing and good functional outcome. Auricular composite grafts are a reliable and effective option for nasal ala reconstruction. The technique demonstrates a favorable balance between functional restoration and cosmetic appearance, with an acceptable complication rate. Careful selection of patients, suitable conditions and an additional vascular bed provided by turndown flap of lining allow a better survival of not only of standard size grafts but even slightly bigger grafts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Can State Family Support Policies Level the Playing Field for Early-Career Women in Plastic Surgery? An Analysis of Web-Scraped Data.

For the young plastic surgeon, the quantity of first-author peer-reviewed publications plays a prominent role in job offers and promotions. Women surgeons carry a disproportionate share of family responsibilities, contributing to their lower representation in positions of leader- ship and influence. Policies protecting reproductive rights and mandating paid family leave (PFL) boost women's participation and productivity in the workplace. However, these policies vary by U.S., state and territory. Web-scraped publication data from all PubMed-indexed plastic surgery journals from 2010 to 2022 were evaluated by first-author gender and affiliated state reproductive rights policy and PFL. Female first authors were further compared with men by publication output (1 article; ≥ 2; ≥ 5) by gender and by affiliated state policies. Protective reproductive rights policies were associated with greater representation of female first authors (3.3 percentage points; p value = 0.003). Protective reproductive rights policies and PFL were associated with a decreased publication gender gap (0.13 articles, p value < 0.001, and 0.18 articles, p value < 0.001, respectively). Protective reproductive policies and PFL had an even greater correlation with higher publication output among female first authors. Protective reproductive rights and mandatory PFL are not only correlated with women's representation among early-career researchers but with a reduction in the publication gender gap. Legislation and policies aimed at supporting women's family responsibilities are associated with higher research productivity among women and likely play a significant role in attracting more women to higher academic ranks and improving gender equity in professional success in plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison between in situ fixation and fixation after closed reduction in valgus impacted femoral neck fractures: A Multicenter Study.

The objective of this study was to compare clinical outcomes between in situ fixation and fixation after closed reduction (CR) in patients aged 50 and above with valgus impacted femoral neck fractures using data from multiple centers. Design: Retrospective multicenter cohort study. Five tertiary-care university hospitals. Patients aged 50 and above, treated with operative fixation of valgus impacted femoral neck fractures using multiple cannulated screws from 2003 to 2019. Complications such as fixation failure, osteonecrosis of femoral head (ONFH), and reoperation were compared between the groups (in situ fixation group and fixation after CR group). Postoperative EuroQol-5 Dimension (EQ-5D), Harris Hip Score (HHS), and Koval's grade were compared. The mean age of the 206 patients (161 in situ fixation group, 45 in fixation after CR group) who met the inclusion criteria was 68.9 ± 10.9 years (range, 50 to 95 years). There were 39 men and 167 women. Fixation failure occurred in 11.2% (6.8% of in situ fixation group vs 26.7% of fixation after CR group, p = 0.002). Reoperation was required for 10.2% (7.5% of in situ fixation group vs 20% of fixation after CR group, p = 0.023). Fixation failure and reoperation rates were significantly higher in the fixation after CR group than in the in-situ fixation group (odds ratio = 4.757, p = 0.002 and odds ratio = 3.104, p = 0.023, respectively). At the two-year follow-up, ONFH occurred in 5.8% (9 out of 161, in situ fixation group vs 3 out of 45, fixation after CR group). There was no significant difference in the occurrence of ONFH between the two groups (p = 0.727). The Koval's grade at 6 and 12 months demonstrated better results in the in-situ group (p = 0.027, 0.044, respectively). Postoperative EQ-5D and HHS scores showed no statistically significant differences between the two groups. In patients aged 50 years or older with valgus impacted femoral neck fractures, when fixation was done after reduction, the reoperation rate was higher due to fixation failure compared to in-situ fixation. There was no significant difference in the incidence of ONFH in valgus impacted femoral neck fractures regardless of whether reduction was performed. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The Experience and Complications of Lipoabdominoplasty for Chinese Post-bariatric Population.

The increasing prevalence of bariatric surgeries in China has led to a growing number of patients experiencing massive weight loss and abdominal skin laxity. However, there is a scarcity of reports addressing post-bariatric lipoabdominoplasty in these patients. This study aims to present our clinical experiences with lipoabdominoplasty in post-bariatric patients in China. We performed lipoabdominoplasty on patients who had abdominal skin laxity following bariatric surgery between March 2018 and October 2023. The procedure encompassed abdominal liposuction, plication of the rectus abdominis muscles, umbilical transposition and progressive tension sutures. Complications were recorded and analyzed. The cohort consisted of 23 post-bariatric patients who underwent lipoabdominoplasty, achieving aesthetically favorable results. The average age at the time of surgery was 31.5years, and the mean body mass index (BMI) was 25.1kg/m2.The overall complication rate was 34.8% (8 out of 23 patients), with hypertrophic scar being the most prevalent complication at 30.4%, followed by partial skin necrosis (4.3%). For the Chinese post-bariatric patients, traditional lipoabdominoplasty may be preferred over fleur-de-lis abdominoplasty. The primary complication observed in our patients is hypertrophic scar. Chinese patients experience a lower rate of other complications, potentially attributed to their lower pre-surgery BMI and younger age. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Vulva Self-Image and Sexual Function After Female External Genital Plastic Surgery.

Female external genital plastic surgery (vulvoplasty) is among the most performed aesthetic surgeries in Brazil. Vulva self-image can be defined as women's perception of their vulva and is usually related to sexual function. The objective of this study was to evaluate the impact and interrelationship of female external genital plastic surgery on self-image and sexual function. This quantitative longitudinal descriptive study includes a retrospective analysis of 48 medical records from June 2017 to July 2021. The sexual function questionnaire (SFQ-28) and female genital self-image scale (FGSIS) answered by the patients in the preoperative and six postoperative month were analyzed. The mean age of the operated patients was 36.25 years (range 18-59). The median FGSIS score was 13 in the preoperative and 27.5 in the six postoperative month, with a significant positive difference in all items. There was a significant positive difference in the following SFQ-28 domains: desire, arousal (cognitive), orgasm, enjoyment, and partner (p < 0.005) CONCLUSION: In our cohort, female external genital plastic surgery (vulvoplasty) elicited a positive relationship between genital self-image and sexual function, in addition to improving orgasm. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Median Nerve Displacement during Hardware Removal after Distal Radius Fractures

Abstract Background This retrospective study aimed to evaluate median nerve displacement observed during hardware removal procedures following volar plating for distal radius fractures. Methods We reviewed all cases involving removal of distal radial volar locking plates at our institution by two surgeons from 2016 to 2021. Plating procedures and hardware removals were performed using the flexor carpi radialis (FCR) approach. We examined the position of the median nerve at the time of hardware removal. Results Median nerve displacement to the radial side of the FCR occurred in 17 out of 67 cases (25%). There were no significant differences in the degree of fracture severity or involved surgeons between the normal position and displaced groups. Conclusions The median nerve may be displaced radially from the FCR during hardware removal, and care should be taken to avoid causing iatrogenic nerve injury. Level of Evidence Level II.

Artificial intelligence’s current involvement in urology and future implementation in clinical environments

Artificial intelligence (AI) is a set of computational methods that interprets the data given, uncovers the underlying patterns associated with the complexity of data, and provides the prediction of outcomes that have become increasingly relevant in urology. The current application of AI in urology predominately focuses on disease diagnosis and risk factor analysis in urologic oncology and male infertility. While many candidate models have been proposed in the literature, efforts to construct clinically meaningful data by incorporating patient-specific and multidisciplinary approaches should be carried out to improve the clinical applicability of AI in driving personalised treatment planning and disease prognosis. Looking forward, AI has the potential to drive targeted training in urology, from surgical techniques to patient-specific surgical procedure simulation, in combination with other technologies such as augmented reality. In order to achieve this, patient involvement should be considered in the model development stage, which also addresses issues surrounding the ethical deployment of AI in the clinical environment. It is possible to see AI playing a collaborative role with surgeons in improving clinical efficiency in the future. Level of evidence: Not Applicable

Barriers, facilitators and next steps for sustaining and scaling virtual hospital services in Australia: aqualitative descriptive study.

To describe the barriers to and facilitators of implementing and delivering virtual hospital (VH) services, and evidence and practice gaps where further research and policy changes are needed to drive continuous improvement. Qualitative descriptive study. Online semi-structured interviews and a focus group were conducted between July 2022 and April 2023 with doctors, nurses and leadership staff involved in VH services at three sites in New South Wales, Australia. Barriers to and facilitators of implementing and delivering VH services in sites with differing operating structures and levels of maturity, and evidence and practice gaps relating to VH services. A total of 22 individuals took part in the study. Barriers, facilitators, and evidence and practice gaps emerged within five major themes: scope and structure of VH services; development and implementation of VH models of care; delivery of VH models of care; evaluation of VHs and VH models of care; and sustainment and scalability of VH services. Facilitators of VH success included hybrid approaches to care, partnerships with external services, and skills of the VH workforce. Barriers and gaps in evidence and practice included technical challenges, the need to define the role of VH services, the need to evaluate the tangible impact of VH care models and technologies, and the need to develop funding models that support VH care delivery. Participants also highlighted the perceived impacts and benefits of VH services on the workforce (within and beyond the VH setting), consumers, and the health care system. Our findings can help inform the development of new VH services and the improvement of existing VH services. As VH services become more mainstream, gaps in evidence and practice must be addressed by future research and policy changes to maximise the benefits.

Peripartum cardiomyopathy: current state of the problem

Peripartum cardiomyopathy (PCMP) is cardiomyo-pathy with left ventricular systolic dysfunction that develops in late pregnancy or in the first months of postpartum period. Clinical manifestations can vary from mild or moderate to severe symptoms of heart failure with significant functional limitation and high mortality. PCMP has a rather heterogeneous and incompletely studied pathophysiology, which includes hormonal, vascular, metabolic, and immunological pathways, whose implementation becomes possible on the background of genetic predisposition. Treatment is based on heart failure therapy, taking into account the risks associated with pregnancy and lactation. Bromocriptine is being considered as a specific therapy; however, the level of evidence for such treatment is insufficient. The article covers basic information about the pathophysiology, diagnosis, prognosis, prevention and treatment of PCMP at the current stage. For writing this review, the literature search was conducted using the MEDLINE, Scopus, and Web of Science databases.

Levels of evidence supporting recommendations in gastroenterology.

We aimed to analyze gastrointestinal guidelines to assess quality of evidence and strength of recommendation. We abstracted clinical practice guidelines and guidance statements from 4 American GI societies (ACG, AGA, ASGE and AASLD) and the United States Multi-Society Task Forc. Of the 3,609 statements analyzed, only 13% were supported by high level of evidence. The number of statements published annually is increasing, but the level of evidence supporting recommendations is declining over time. This analysis highlights the need for high quality research in GI to support the development of stronger evidence-based guideline statements.

Management guidelines for pregnant women living with epilepsy: An integrative literature review

Background: Epilepsy affects more than 50 million people worldwide, with a significant number of safety-related concerns arising in pregnant women. Precise management needs to include a vast array of stepwise protocols; however, no studies have been conducted to compare current South African guidelines to international norms.Aim: The aim of this integrative literature review was to identify discrepancies, if any, in the current protocols for treating pregnant women with epilepsy within the public sector of South Africa when measured against global standards.Method: An integrative literature review was conducted using the Whittemore and Knafl method. The following databases and search engines were used: PubMed, EBSCOhost, Science Direct, Medscape, African Journals Online, Cochrane Library, Google scholar, Google and MedlinePlus. The study included qualitative literature from all levels of evidence from 2006 to 2023. The data were evaluated using the PRISMA flow chart and analysed using the Cooper method. On completion of critical appraisal, 22 articles met the inclusion criteria and were analysed thematically.Results: The review identified several areas that can be enhanced to improve patient management and outcomes such as therapeutic drug monitoring and targeted dosing, folic acid supplementation, the use of antepartum vitamin K, high-resolution ultrasounds, elimination of sodium valproate in women of childbearing potential, monotherapy and endorsing frequent obstetrician visits.Conclusion: The study validated many differences between guidelines used in South Africa and internationally. Some of the prominent findings included areas focused on patient medication, screening, physician visits and pharmacovigilance.Contribution: The findings can be used to enhance and provide evidence-based recommendations in the areas that are not well developed within the current guidelines.

Femoral shaft fractures in preschool children: external fixation and elastic intramedullary nail treatments in clinical practice.

Surgical intervention in preschoolers with femoral shaft fractures has increased due to the evolving lifestyle. This study aimed to analyze and compare the efficacy of elastic intramedullary nailing and external fixation in treating femoral shaft fractures in children aged 2-5. Ninety-nine pediatric patients were categorized into the external fixator (EF) and the elastic intramedullary nail (ESIN) group based on surgical techniques. Data on follow-up, intraoperative parameters, postoperative complications, fracture features, and demographics were gathered and compared. The mean duration of follow-up was 32 months, ranging from 25 to 48 months. All fractures had healed completely and no instances of nonunion were observed. At the latest follow-up, within the EF group, there were instances of malunion, delayed union, and refracture, each occurring once. One case in every group exhibited a leg length difference above 2 cm. The external fixation group had a shorter operation duration (P = 0.04), fewer intraoperative fluoroscopy times (P < 0.01), earlier partial weight-bearing time (P < 0.01), and full weight-bearing time (P < 0.01), while a greater complication rate (29.8 vs. 14.3%, P = 0.07) compared with the ESIN group. The incidence of pin tract infection in the EF group was 21.1% (12/57) compared with 2.4% (1/42) in the ESIN group (P = 0.07). Eighty percent of the patients' families expressed concern about the residual scar after removing the EF. The ESIN group encounters fewer complications and positive aesthetic effects, making it a preferable treatment option in this specific patient population and fracture pattern. Level of evidence: Class III, retrospective comparative study.

Pulmonary MRI in Newborns and Children.

Lung MRI is an important tool in the assessment and monitoring of pediatric and neonatal lung disorders. MRI can provide both similar and complementary image contrast to computed tomography for imaging the lung macrostructure, and beyond this, a number of techniques have been developed for imaging the key functions of the lungs, namely ventilation, perfusion, and gas exchange, through the use of free-breathing proton and hyperpolarized gas MRI. Here, we review the state-of-the-art in MRI methods that have found utility in pediatric and neonatal lung imaging, the structural and physiological information that can be gleaned from such images, and strategies that have been developed to deal with respiratory (and cardiac) motion, and other technological challenges. The application of lung MRI in neonatal and pediatric lung conditions, in particular bronchopulmonary dysplasia, cystic fibrosis, and asthma, is reviewed, highlighting our collective experiences in the clinical translation of these methods and technology, and the key current and future potential avenues for clinical utility of this methodology. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

DE-PASS Best Evidence Statement (BESt): A Systematic Review and Meta-analysis on the Effectiveness of Trials on Device-Measured Physical Activity and Sedentary Behaviour and Their Determinants in Children Aged 5-12 Years.

To combat the high prevalence of physical inactivity among children, there is an urgent need to develop and implement real-world interventions and policies that promote physical activity (PA) and reduce sedentary behaviour (SB). To inform policy makers, the current body of evidence for children's PA/SB interventions needs to be translated. The current systematic review and meta-analysis aimed to identify modifiable determinants of device-measured PA and SB targeted in available intervention studies with randomized controlled trial (RCT) and controlled trial (CT) designs in children and early adolescents (5-12 years) and to quantify the effects of the interventions within their respective settings on the determinants of PA/SB and the outcomes PA and SB. A systematic search was conducted in MEDLINE, PsycINFO, Web of Science, SPORTDiscus and CENTRAL. Studies were considered if they were randomized controlled trials (RCTs) or controlled trials (CTs), included children and/or early adolescents (5-12years; henceforth termed children), measured PA and/or SB using device-based methods and measured PA and/or SB and determinants of PA/SB at least at two timepoints. Risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomised Trials (RoB2) for RCTs and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) for CTs. The quality of the generated evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Robust Bayesian meta-analysis was conducted to quantify the effects of the interventions on the determinants of PA/SB, and the outcomes PA and SB, stratifying by study design, duration of PA/SB measurement, intervention setting and duration of follow-up measurement. Study characteristics and interventions were summarized. Thirty-eight studies were included with a total sample size of n = 14,258 (67% girls). Settings identified were school, family/home, community and combinations of these. The review identified 38 modifiable determinants, spanning seven categories on individual, interpersonal and physical environmental levels, with 66% of determinants on the individual level. Overall, the results indicated trivial-to-moderate effects of the interventions on the determinants of PA and SB, with mostly trivial level of evidence for the presence of an effect (as indicated by a small Bayes factor; BF10 < 3.00). The exceptions were moderate effects on parental PA modelling in the family/home setting and SB measured during specific parts of the school day. Higher quality of evidence was found in the family/home setting compared with other settings. Overall, the results indicated that interventions have neither been effective in modifying the determinants of PA/SB, nor changing the PA/SB outcomes in children. In general, the approach in the current review revealed the breadth of methodological variability in children's PA interventions. Research is needed to address novel approaches to children's PA research and to identify potential determinants to inform policy and future interventions. International prospective register of systematic reviews (PROSPERO): CRD42021282874.