Multicenter Comparative Study Research Articles

Risk of Zonular Dialysis in Fellow-Eye Cataract Surgeries: A Multicenter Comparative Study.

To evaluate the risk of zonular dialysis (ZD) in fellow eye phacoemulsification cataract surgery and to identify risk factors, including prior first eye ZD. 8 United Kingdom National Health Service clinical centers. Retrospective database study. We calculated the overall risk of ZD in the fellow eye and reported the odds ratio (OR) for the various risk factors, including first eye ZD. The main outcome measures were the risk and the predictors of intraoperative ZD in the fellow eye. There was a total of 66,288 patients. At the time of the first surgery, the mean age of patients was 75.3±10.2 years, and 39.2% were males. Intraoperative ZD occurred during the first eye surgery in 333 patients (0.5%) and the fellow eye in 349 patients (0.5%). The risk of fellow eye developing ZD in patients with first eye ZD was higher than in patients without first eye ZD: 23/333 patients (6.9%) vs. 326/65,955 patients (0.5%) (p<0.001, unadjusted OR=14.9). In the adjusted logistic regression model, first eye ZD was the most significant risk factor (OR=13.3, 95% confidence interval (CI) =8.2-21.7). Other significant covariates of ZD in the fellow eye were pseudoexfoliation (OR=6, CI=3.8-9.7), previous pars-plana vitrectomy (OR=4.5, CI=1.1-18.5), and poor pupillary dilatation (OR=2.2, CI=1.4-3.3). The most important risk factor for the development of ZD in the fellow eye during cataract surgery was the occurrence of ZD in the first eye. Our findings have implications for patient counseling and surgery allocation.

Impact of perioperative high-protein nutritional support on the quality of life of patients with primary lung cancer: a Russian prospective multicenter comparative study (NUTRILUNC study)

BACKGROUND: Individuals over the age of 70 comprise over half of operable patients with stage 0–IIIA lung cancer. In the early postoperative period of this cohort, pain, fatigue, insomnia, and/or mood disturbances are the four most common symptoms, which can significantly diminish quality of life and functional status. Perioperative nutritional support in such patients, which enhances exercise tolerance, can have a positive impact on their quality of life and socialization. AIM: To assess the effect of perioperative nutritional support using high-protein oral nutrition supplements on the general health and quality of life of non-small cell lung cancer patients during the postoperative period. MATERIALS AND METHODS: Patients with primary non-small cell lung cancer (n=112, 69 males), aged 57.2±8.2, who were awaiting lung surgery and at risk of malnutrition (Nutritional Risk Screening Assessment 2002 score ≥3) were randomly assigned into two groups. Oral nutritional support (Nutridrink Compact Protein, Nutricia LLC) was administered to the study group (n=55) at a rate of 250 ml/d (36 g of protein, 612 kcal) for 14 days prior to and 14 days following the surgery, in addition to the standard diet. Control group patients (n=57) were provided a standard diet. The quality of life was assessed using the Quality of Life Questionnaire Core-30. Results are presented as mean ± standard deviation. Differences were considered significant at p ≤0.05. RESULTS: Throughout the entire observation period, the study group exhibited superior growth indicators in terms of general health status, physical, and role functioning than the control group (p 0.05). The study group patients exhibited a propensity toward improved emotional functioning, and by the end of the study, weakness and insomnia were less pronounced (p 0.05). Other indicators did not exhibit any significant variations. CONCLUSION: Нigh-protein perioperative oral nutrition supplements exert a positive impact on the quality of life of non-small cell lung cancer patients.

Outcomes of Cataract Surgery Complicated With Zonular Dialysis: A Multicenter Comparative Study

Purpose To compare the visual outcomes, rate of cystoid macular edema (CME), and additional associated complications in eyes that exhibited zonular dialysis (ZD) during phacoemulsification to a reference group of uneventful phacoemulsification eyes. Methods A retrospective multicenter comparative database study. We pooled data from 8 United Kingdom sites between 2003 and 2015. The main outcome measures were the mean postoperative visual acuity (VA) at 12–24 weeks and the rates of CME and additional associated complications. Results We included 1074 eyes in the ZD group and 112,479 in the reference group. Logistic regression analysis showed that pseudoexfoliation was the strongest associated factor of ZD (OR: 6.1), followed by previous glaucoma surgery (OR: 4.4). Mean logMAR preoperative VA was 0.8 ± 0.6 in the ZD group vs. 0.6 ± 0.5 in the reference group (p < 0.001). Mean postoperative VA was worse in the ZD group (p < 0.001); 0.4 ± 0.6 vs. 0.2 ± 0.3 and 0.5 ± 0.6 vs. 0.2 ± 0.3 at 4–12 weeks and 12–24 weeks, respectively. At 12–24 weeks, the proportions of eyes that gained ≥0.3 logMAR units were 50% in the ZD group vs. 62% in the reference group (p < 0.001). In the ZD group, the most common intraoperative complication was vitreous loss (34.3%), followed by posterior capsular rupture (PCR) (11.1%). Postoperative CME occurred in 2.3% vs. 1.4% (p = 0.01), and 9.3% of eyes required surgery for correction of aphakia, intraocular lens decentration, or dropped lens figments removal. Conclusions The occurrence of ZD was associated with worse postoperative vision, an increased rate of vitreous loss and PCR, and a higher risk of CME.

Biopsychosocial Impact of Multiple Sclerosis in Omani Patients: A Multicenter Comparative Study.

Background/Objectives: Multiple sclerosis (MS) is a chronic neurological disorder characterized by various clinical presentations and manifestations that include biopsychosocial impediments. This study has three interrelated goals relevant to biopsychosocial functioning: (i) compare reasoning ability, neuropsychological functioning, affective range, and quality of life (QoL) between people with multiple sclerosis (PwMS) and healthy controls; (ii) explore gender differences in reasoning ability and neuropsychological functioning, affective symptoms, and QoL among PwMS; and (iii) examine the relationship between QoL and cognitive performance in PwMS, focusing on those with inadequate vs. adequate QoL. Methods: This multicenter study was carried out among clinically stable PwMS (no relapse in the last two months) at follow-up in two tertiary care units in urban Oman. Healthy controls, matched for age and sex, were also recruited as a comparison group. Data were collected using cognitive batteries sensitive to current reasoning ability and conventional neuropsychological batteries designed to measure verbal learning, visual-spatial ability, and processing speed. The affective range (anxiety and depressive symptoms) and quality of life (QoL) were also evaluated. Results: The PwMS group scored lower on current reasoning ability, verbal learning, visual-spatial ability, and processing speed compared to the control group. The incidence of anxiety was higher in the PwMS group, but there were no statistically significant differences in depressive symptoms. No significant differences were found in cognitive variables between the two sexes, except in visual-spatial ability, where women outperformed men. PwMS with low QoL scored lower on attention and concentration indices than those with adequate QoL. According to QoL, no significant differences were observed in reasoning, verbal learning, or visual-spatial ability. Conclusions: The present sentinel study suggests that the Omani cohort with MS tends to have lower indices of current reasoning ability, visual and spatial memory, and cognitive speed compared to control subjects. Gender differences are minimal, except for visual-spatial abilities, where women outperform men. Quality of life significantly affects cognitive functioning. In general, the biopsychosocial impediment appears to be significant, indicating the need for comprehensive evaluation and care in the management of MS.

Risk of Posterior Capsule Ruptures in Fellow-Eye Cataract Surgeries: A Multicenter Comparative Study

ABSTRACT Purpose To quantify the risk of posterior capsule rupture (PCR) in fellow-eye phacoemulsification surgery and to determine risk factors. Methods We pooled data from 8 United Kingdom sites for patients undergoing bilateral non-simultaneous phacoemulsification. Main outcome measures were the incidence and risk factors of the development of PCR during the fellow-eye phacoemulsification. Results We included 66,288 patients with a mean age of 75.3 ± 10.2 years. PCR during phacoemulsification occurred in the first eye in 932 patients (1.4%) and the fellow eye in 1039 patients (1.5%). The risk of fellow eye developing PCR in patients with PCR in the first eye was significantly higher than in patients without first eye PCR: 30 patients (3.2%) vs. 1009 (1.5%), respectively (odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.1-2.7). Other risk factors for fellow-eye PCR included zonular dialysis (OR = 5.4, CI = 3.3-7.8) and advanced cataract (OR = 2.8, CI = 2.1-3.7). Conclusions History of PCR in the first-operated eye is an independent risk factor for PCR in the fellow eye.

Multicenter comparative study of polysomnography outcomes in children with the monogenic disorder sickle cell disease.

Sleep-disordered breathing (SDB) is prevalent in children with sickle cell disease (SCD) and is associated with worse outcomes. This study aims to compare the outcomes of polysomnography (PSG) performed for pediatric patients with SCD at three United States centers. We included children with SCD aged 0-21 who underwent PSG at three American Academy of Sleep Medicine accredited centers: the University of Alabama at Birmingham (UAB), the University of Florida (UF), and Duke University Hospital (DUH), between 2012 and 2022. Descriptive statistics were used as appropriate to compare the baseline characters and PSG outcomes among the different centers. A total of 210 children with SCD from the three centers were included, with comparable sex, SCD genotypes, hemoglobin, hematocrit levels, and chronic transfusion. Children from the different centers exhibited variations in age (P < .001), BMI (P < .05), mean corpuscular volume (P < .05), and hydroxyurea use (P < .05) at the time of the PSG. Overall, the three centers showed significantly different PSG outcomes. Patients from UF had worse obstructive sleep apnea, oxygenation, and periodic leg movement events, together with lower hydroxyurea usage. While those from DUH showed higher hypoventilation and arousal indices. This multicenter study underscores variations in PSG outcomes among pediatric SCD patients at different centers in the Southeast United States. These findings emphasize the need for standardized approaches to screen for SDB, refer to PSG, and interpret the results in children with SCD. These conclusions may apply to other genetic disorders associated with an increased risk of sleep-disordered breathing.

Intraoperative fluid management in adult spinal deformity surgery: variation analysis and association with outcomes.

To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS). Multicenter comparative cohort study. Patients ≥ 18years old and with ASD were included. Intraoperative intravenous (IV) fluid data were collected including: crystalloids, colloids, crystalloid/colloid ratio (C/C), total IV fluid (tIVF, ml), normalized total IV fluid (nIVF, ml/kg/h), input/output ratio (IOR), input-output difference (IOD), and normalized input-output difference (nIOD, ml/kg/h). Data from different centers were compared for variability analysis, and fluid parameters were analyzed for possible associations with the outcomes. Seven hundred ninety-eight patients with a median age of 65.2 were included. Among different surgical centers, tIVF, nIVF, and C/C showed significant variation (p < 0.001 for each) with differences of 4.8-fold, 3.7-fold, and 4.9-fold, respectively. Two hundred ninety-two (36.6%) patients experienced at least one in-hospital complication, and ninety-two (11.5%) were IV fluid related. Univariate analysis showed significant relations for: LOS and tIVF (ρ = 0.221, p < 0.001), IOD (ρ = 0.115, p = 0.001) and IOR (ρ = -0.138, p < 0.001); IV fluid-related complications and tIVF (p = 0.049); ICU stay and tIVF, nIVF, IOD and nIOD (p < 0.001 each); extended ICU stay and tIVF (p < 0.001), nIVF (p = 0.010) and IOD (p < 0.001). Multivariate analysis controlling for confounders showed significant relations for: LOS and tIVF (p < 0.001) and nIVF (p = 0.003); ICU stay and IOR (p = 0.002), extended ICU stay and tIVF (p = 0.004). Significant variability and lack of standardization in intraoperative IV fluid management exists between different surgical centers. Excessive fluid administration was found to be correlated with negative outcomes. III.

Retroperitoneal cutaneous ureterostomy following radical cystectomy: A multicenter comparative study of robotic versus open surgery.

The aim of this study was to evaluate the differences in perioperative outcomes of cutaneous ureterostomy (CUS) between open surgery (open radical cystectomy, ORC) and robot-assisted surgery (robot-assisted radical cystectomy, RARC), including the stent-free rate, readmission rates due to urinary tract infection (UTI), and changes in renal function. Between 2005 and 2023, a total of 37 patients underwent CUS following ORC, while 24 patients underwent CUS following RARC. Perioperative outcomes were compared between these two groups. The patients in the RARC group were significantly older (p = 0.007) and had a significantly higher proportion of high-risk cases with ASA-PS ≥3 (p = 0.002). In addition, RARC was associated with a significantly lower estimated blood loss (p < 0.001) and a reduced transfusion rate (p = 0.003). Postoperative complication rates and the stent-free rate were comparable between the ORC and RARC groups. Throughout a median follow-up period of 2.6 years, rates of readmission due to UTI did not differ significantly between the two groups. Moreover, there were no differences in the change in estimated glomerular filtration rate before and after surgery and the 3-year survival rates were similar across both groups. CUS following RARC appears to offer a safer alternative compared with CUS following ORC, and the stent-free rates are comparable. The significantly lower estimated blood loss and transfusion rate associated with RARC are particularly favorable for elderly patients, those who are frail, and individuals with multiple comorbidities.

How to improve medical students’ ECG interpretation skills ? Multicenter survey and results of a comparative study evaluating a new educational approach

BackgroundLearning to interpret electrocardiograms (ECGs) is a crucial objective in medical education. Despite its importance, errors in ECGs interpretation are common, and the optimal teaching methods have not yet been clearly established.ObjectivesTo evaluate students’ confidence in ECGs analysis and their opinion on current teaching methods, and to assess the effectiveness of a new ECG educational approach.MethodsFirst, we conducted a survey on ECG learning among fourth to sixth-year medical students. Second, a 5-week multicenter comparative study was conducted with fourth-year medical students during their cardiology internship. Two different teaching methods were used, assigned by center. The first group participated in 5-minutes workshops 4 times a week using a “reversed classroom” method, supervised by a cardiologist, where students took turns selecting, presenting and discussing ECGs. The control group attended a single 2-hour face-to-face ECG course. All participants completed a 30-minute ECGs analysis test at baseline and after 5 weeks.ResultsOut of 401 survey respondents, the confidence levels in ECG interpretation were 3/5 (IQR 2–3) for routine situations and 2/5 (IQR 1–3) for emergency situations. Satisfaction with ECG teaching was low (2/5, IQR 1–3) and 96.3% of respondents favored more extensive ECG training. In the comparative study, 52 students from 3 medical schools were enrolled (control group: n = 27; workshop group: n = 25). Both groups showed significant improvement in exam scores from baseline to 5-week (33/100 ± 12/100 to 44/100 ± 12/100, p < 0.0001 for the control group and 36/100 ± 13/100 to 62/100 ± 12/100, p < 0.0001 for the workshop group). The improvement was significantly greater in the workshop group compared to the control group (+ 26 ± 11 vs. + 11 ± 6, p < 0.001).ConclusionsAmong French medical students who initially reported low confidence and insufficient skills in ECG interpretation, the workshop approach using a “reversed classroom” method was found to be more effective than conventional lecture-based teaching during cardiology internship.Graphical abstract

A multicenter comparative cohort study of severe maculopapular exanthema and drug reaction with eosinophilia and systematic symptoms

A multicenter comparative cohort study of severe maculopapular exanthema and drug reaction with eosinophilia and systematic symptoms

Biological Fixation of AC Joint using Autologous Semitendinosus Graft in Acute Type III-VI Acromioclavicular Joint Dislocations—A Pilot Study

ABSTRACT Introduction: Injuries to the acromioclavicular (AC) joint can range from modest, transient pain to significant displacement, chronic pain, and shoulder biomechanical changes that result in long-term disability. Aim and Objective: We aimed to evaluate the functional outcome of anatomical reconstruction of ACJ using autologous semitendinosus graft in type III-VI AC joint dislocations. Materials and Methods: In this study, 20 patients with AC joint dislocation (Rockwood type III-VI) were managed by surgical fixation using autologous semitendinosus graft from November 01, 2019, to October 31, 2020, at our center. After providing written informed consent, the study enrolled patients who satisfied the inclusion criteria. Preoperative, three-month, and six-month UCLA shoulder scores were assessed. Results: Mean age of participants was 36.5 years (SD: 9.86). Radiological evaluation at each visit suggested a 100.0% success rate of this method. 95% of the participants had no complications, while 5.0% had DVT. No participants had SSI. Conclusions: Autologous semitendinosus graft fixation of type III-VI AC joint injuries is a viable surgical option with the advantages of being a biological fixation, single surgery, and having excellent functional outcomes. However, extensive multicentric comparative studies are required to draw definitive conclusions.

Voice quality after surgery or radiotherapy for glottic T1 squamous cell carcinoma: Results of the VOQUAL study

PurposeMany series have compared voice quality after radiotherapy or surgery for cT1 glottic carcinoma. Different meta-analyses identify better results for radiotherapy while others do not identify any difference, some finally find a superiority of surgery. The purpose of this study was to compare the voice quality in the long term of patients who underwent transoral surgery versus exclusive irradiation for the treatment of cT1 glottic carcinoma. Material and methodsThe VOQUAL study was a pilot comparative multicenter cross-sectional study. The primary endpoint was the Voice Handicap Index comparison between two groups (radiotherapy or surgery). The voice assessment also consisted in the heteroevaluation of voice quality by the Grade, Roughness, Breathness, Asthenia, and Strain rating scale reported by Hirano. ResultsThe study included 41 adult patients with cT1 carcinoma of the vocal cord treated by cordectomy or exclusive radiation in two oncologic centers. The median Voice Handicap Index value was 20 [8; 32.5] in the surgery group and 10 [4; 18.5] in the radiotherapy group. There was no statistically significant difference between the median values and the various components F, P and E of the questionnaire (P=0.1585). The median value of the numeric dysphonia Grade, Roughness, Breathness, Asthenia, and Strain scale was 2 [0; 5] in the surgery group and 2 [0.25; 3.75] in the radiotherapy group. There was no statistically significant difference between these values (P=0.78). ConclusionOur study did not show any significant difference on the primary endpoints of Voice Handicap Index and Grade, Roughness, Breathness, Asthenia, and Strain scores. Level of evidenceIII. Clinical trial registration: The VOQUAL study was registered on the ClinicalTrials.gov platform under the number NCT04447456, in July 2020.

Evaluating no fixation, endoscopic suture fixation, and an over-the-scope clip for anchoring fully covered self-expanding metal stents in benign upper gastrointestinal conditions: a comparative multicenter international study (With Video)

Fully covered self-expandable metal stents (FCSEMSs) are widely used in benign upper gastrointestinal (GI) conditions, but stent migration remains a limitation. An over-the-scope clip (OTSC) device (Stentfix {SF], Ovesco Endoscopy) for stent anchoring has recently been developed. The aim of this study was to evaluate the effect of OTSC fixation on FCSEMS migration rate. In this retrospective review of consecutive patients who underwent FCSEMS placement for benign upper GI conditions from January 2011 to October 2022 at 16 centers, the primary outcome was rate of stent migration. The secondary outcomes were clinical success and adverse events. A total of 311 (no fixation [NF] 122, SF 94, endoscopic suturing [ES] 95) patients underwent 316 stenting procedures. Compared with the NF group (n= 49, 39%), the rates of stent migration were significantly lower in the SF (n= 16, 17%, P= .001) and ES (n= 23, 24%, P= .01) groups. The rates of stent migration were not different between the SF and ES groups (P= .2). On multivariate analysis, SF (odds ratio [OR], 0.34, 95% CI, 0.17-0.70, P< .01) and ES (OR, 0.46, 95% CI, 0.23-0.91; P= .02) were independently associated with decreased risk of stent migration. Compared with the NF group (n= 64; 52%), there were higher rates of clinical success in the SF (n= 64; 68%; P= .03) and ES (n= 66; 69%; P= .02) groups. There was no significant difference in the rates of adverse events among the 3 groups. Stent fixation using OTSCs is safe and effective at preventing stent migration and may also result in improved clinical response.

Lower physical activity levels in youth with Cystic Fibrosis compared to healthy controls: A multicentre comparative study

BackgroundRegular physical activity (PA) offers significant health benefits on both short (i.e., emotional well-being) and long term (i.e., fewer hospitalizations) in Youth with Cystic Fibrosis (YwCF). Regardless, evidence on PA levels in YwCF compared to healthy controls (HC) is inconsistent. Additionally, PA is a multidimensional outcome influenced by several factors such as Quadriceps strength and functional performance. Therefore, we aimed to assess whether PA, Quadriceps strength and functional performance differ between YwCF and HC across different age groups (i.e., children and adolescents). MethodsYwCF aged 6–17 from two Belgian CF centres and age- and sex-matched HC were recruited. PA was measured with an ActiGraph GT3X + BT during 7 consecutive days. Isometric Quadriceps strength was assessed with a Hand Held Dynamometer and functional performance with a sit-to stand test (STS) and standing long jump (SLJ). ResultsA total of 49 YwCF (44 % male; 11.3 ± 3.3 years) and 49 HC (48 % male; 11.9 ± 3.5 years) were included. On average days, YwCF performed 4 ± 6.4 min less light PA and 7.5 ± 6.7 min less moderate-to-vigorous PA compared to HC (p = 0.04; p = 0.01). The differences in moderate-to-vigorous PA seem more pronounced in children (6–11 years)(p = 0.04). Furthermore, YwCF had similar Quadriceps strength to HC but had lower scores on the STS and SLJ (p = 0.50, p = 0.08; p = 0.02). ConclusionsThis study shows lower PA levels and functional performance for YwCF, indicating that there is an urgent need for interventions promoting PA in YwCF. PA promotion will become increasingly important in the post modulator area to prevent health risks associated with low PA.

Use of Color Channel Optimization in 3D Heads-Up Vitrectomy vs Standard Operating Microscope for Macular Surgeries.

Purpose: To compare the efficacy and safety of color channel optimization with 3-dimensional (3D) heads-up vitrectomy (3D HUD group) vs standard operating microscope vitrectomy (control group) for macular surgery. Methods: This retrospective multicenter comparative study comprised patients having 25-gauge pars plana vitrectomy for macular hole, epiretinal membrane (ERM), or vitreomacular traction. The minimum follow-up was 6 months. Surgeons completed a subjective questionnaire after each case. The main outcome measures were safety related (dye reinjection rate, macular ERM or internal limiting membrane [ILM] peeling time, endoillumination intensity). Other outcome measures included total surgical time, surgical outcomes, and subjective surgeon-related parameters. Results: The study included 74 eyes (36 in 3D HUD group; 38 in control group). There were no statistical differences in baseline parameters between groups. Significantly more eyes in the control group than in the 3D HUD group required dye reinjection (23.7% vs 5.6%; P = .03). Less time was required for ERM and ILM peeling in the 3D HUD group (both P < .01); however, the total surgical time was the same between groups. Eyes in the 3D HUD group required lower endoillumination (P < .001). There were no between-group differences in the rates of complications. Surgeons said depth perception was better in the control group (P < .001), with no differences in comfort or visibility. Conclusions: 3D heads-up-based color channel optimization for macular surgeries is safe and effective. Although it may have safety advantages, it did not affect the visual or anatomic outcomes or total surgical time and did not improve surgeon comfort or visibility.

Long Leg Versus Short Leg Cast Immobilization for Treatment of Salter-Harris II Distal Tibial Fractures After Closed Reduction: A Multisite Retrospective Study

BACKGROUNDDistal tibial physeal fractures are common injuries that can frequently be treated nonoperatively. Most commonly, long leg cast immobilization is recommended after closed reduction. The purpose of this study was to compare outcomes between long leg cast (LLC) and short leg cast (SLC) immobilization after closed reduction of Salter-Harris II (SH-II) distal tibial fractures. METOHDSA retrospective, multicenter comparative study was performed evaluating skeletally immature patients treated with closed reduction of a displaced SH-II distal tibia fracture at three Level I Pediatric Trauma Centers between 2012 and 2018. Radiographs after casting were compared to those at the time of cast removal to assess for the primary study outcome of loss of reduction (LOR). Secondary outcomes included the length of casting, premature physeal closure, time to weight-bearing, and time to release to activities. RESULTSA total of 148 patients with a median age of 12.7 years (IQR 11.2-13.7) met inclusion criteria. LLC were utilized in 110 cases while 38 patients received a SLC. Loss of reduction occurred in 10 patients (6.8%), nine with a LLC and one in a SLC (p=0.454). Those treated in SLC had a shorter length of casting (p=0.030) and quicker release to activities (p=0.004) than those with LLC. CONCLUSIONSFindings of this retrospective, multi-center study show similar rates of loss of reduction between SLC and LLC immobilization for SH-II distal tibial fractures after closed reduction. Patients received less total casting and returned to sports quicker after SLC immobilization. KEYWORDS CONCEPTS•Salter-Harris II distal tibia fractures can be treated with closed reduction and short leg casting without an increased rate of displacement•Distal tibial physeal fractures treated in a short leg cast can possibly return to sports quicker•The rate of interval displacement of a SH-II distal tibia fracture after closed reduction is approximately 6.7%. LEVEL OF EVIDENCELevel III Retrospective Comparative Study

Comment on: Efficacy and safety of two disposable circumcision suture devices for circumcision in adults: a prospective comparative multicenter study.

Comment on: Efficacy and safety of two disposable circumcision suture devices for circumcision in adults: a prospective comparative multicenter study.

Multicenter comparative study of Enterocytozoon bieneusi DNA extraction methods from stool samples, and mechanical pretreatment protocols evaluation

Nowadays, the use of qPCR for the diagnosis of intestinal microsporidiosis is increasing. There are several studies on the evaluation of qPCR performance but very few focus on the stool pretreatment step before DNA extraction, which is nevertheless a crucial step. This study focuses on the mechanical pretreatment of stools for Enterocytozoon bieneusi spores DNA extraction. Firstly, a multicenter comparative study was conducted evaluating seven extraction methods (manual or automated) including various mechanical pretreatment. Secondly, several durations and grinding speeds and types of beads were tested in order to optimize mechanical pretreatment. Extraction methods of the various centers had widely-varying performances especially for samples with low microsporidia loads. Nuclisens® easyMAG (BioMérieux) and Quick DNA Fecal/Soil Microbe Microprep kit (ZymoResearch) presented the best performances (highest frequencies of detection of low spore concentrations and lowest Ct values). Optimal performances of mechanical pretreatment were obtained by applying a speed of 30 Hz during 60 s with the TissueLyser II (Qiagen) using commercial beads of various materials and sizes (from ZymoResearch or MP Biomedicals). Overall, the optimal DNA extraction method for E. bieneusi spores contained in stool samples was obtained with a strong but short bead beating using small-sized beads from various materials.

A comparative cohort study of surgical approaches for adult spinal deformity at a minimum 2-year follow-up.

This study was a retrospective multi-center comparative cohort study. A retrospective institutional database of operative adult spinal deformity patients was utilized. All fusions > 5 vertebral levels and including the sacrum/pelvis were eligible for inclusion. Revisions, 3 column osteotomies, and patients with < 2-year clinical follow-up were excluded. Patients were separated into 3 groups based on surgical approach: 1) posterior spinal fusion without interbody (PSF), 2) PSF with interbody (PSF-IB), and 3) anteroposterior (AP) fusion (anterior lumbar interbody fusion or lateral lumbar interbody fusion with posterior screw fixation). Intraoperative, radiographic, and clinical outcomes, as well as complications, were compared between groups with ANOVA and χ2 tests. One-hundred and thirty-eight patients were included for study (PSF, n = 37; PSF-IB, n = 44; AP, n = 57). Intraoperatively, estimated blood loss was similar between groups (p = 0.171). However, the AP group had longer operative times (547.5min) compared to PSF (385.1) and PSF-IB (370.7) (p < 0.001). Additionally, fusion length was shorter in PSF-IB (11.4) compared to AP (13.6) and PSF (12.9) (p = 0.004). There were no differences between the groups in terms of change in alignment from preoperative to 2years postoperative. There were no differences in clinical outcomes. While postoperative complications were largely similar between groups, operative complications were higher in the AP group (31.6%) compared to the PSF (5.4%) and PSF-IB (9.1) groups (p < 0.001). While there were differences in intraoperative outcomes (operative time and fusion length), there were no differences in postoperative clinical or radiographic outcomes. AP fusion was associated with a higher rate of operative complications.

Double-level osteotomy for varus knees using patient-specific cutting guides allow more accurate correction but similar clinical outcomes as compared to conventional techniques

PurposePatient-specific cutting guides are increasingly used in the field of osteotomies around the knee and can improve the accuracy of planned correction and more specifically in the case of double-level osteotomy (DLO). The purpose of this study was to analyse the accuracy of postoperative coronal alignment after DLO using patient-specific cutting guides techniques (PSI) compared to conventional techniques.The secondary objective was to compare the functional results between the two groups at short-term follow-up. HypothesisThe accuracy of global correction (HKA angle) is better with patient-specific cutting guides compared to conventional techniques for double-level osteotomy MethodsThis multicentric comparative retrospective study included 53 patients (mean age: 53.8 ± 5.2 years, male/female: 44/9) who underwent a DLO for knee varus malalignment. The coronal correction accuracy (as expressed by the difference between postoperative angular values and preoperative targeted correction) was compared between techniques using patient-specific cutting guides (PSI group, n = 27) or conventional techniques (n = 26) for the medial proximal tibial angle (MPTA) and the lateral distal femoral angle (LDFA). Postoperatively, the global alignment expressed by the hip-knee-ankle angle and the joint line obliquity were compared between groups. The postoperative functional results for KOOS and UCLA activity scale score were also compared at a mean follow-up of 1.7 years (1.0–3.1 years). ResultsNo difference was observed for the postoperative global alignment between the PSI and the conventional groups (Δ = 0.6 °, p = 0.11) neither for the postoperative posterior proximal tibial angle (Δ = 1.6°, p = 0,99) or the joint line obliquity (Δ = 0.3°, p = 0,17). In the coronal plane, the postoperative MPTA was lower in the PSI group (Δ = 2.3°, p < 0.001) as well as the postoperative LDFA (Δ = 0.9°, p = 0.01).Concerning correction accuracy in the coronal plane, the results showed a significant higher accuracy of the planned correction in the PSI group compared to the conventional group for MPTA (2.2 ± 0.2 versus 0.8 ± 0.7, Δ = 1.5 °, p < 0.001) and LDFA (1.3 ± 1.0 versus 0.6 ± 0.9, Δ = 0.7°, p < 0.001).No improvement difference was observed between the conventional group and the PSI group respectively for the KOOS symptoms (p = 0.12), the KOOS Pain (p = 0,57), the KOOS activities of daily living (p = 0.61), the KOOS sport/rec (p = 0.65), or for the KOOS Quality of Life (p = 0.99) neither for the UCLA (p = 0.97). ConclusionsThis study suggests that the use of custom-made cutting guides improves the accuracy of planned correction in double-level osteotomy compared with conventional techniques, which may have implications particularly in centers not performing a large volume of osteotomies.This improved accuracy is not associated with any difference in joint line obliquity or functional results but these results need to be confirmed by a randomized prospective study. Level of evidence: III; Retrospective comparative study