Comparison Of Outcomes Research Articles

Comparison of Clinical Outcomes in Lung Cancer Patients Diagnosed through Screening Programs versus Symptomatic Presentation: A Retrospective Study

Objectives The objective of this study is to compare the clinical outcomes of lung cancer patients diagnosed through screening programs (workplace screening, premarital screening, and check-up programs) and those diagnosed based on symptomatic presentation, all of whom underwent video-assisted thoracoscopic surgery (VATS) lobectomy or segmentectomy between 2019 and 2021. Methods A retrospective study was conducted involving 45 patients diagnosed with stage I and II lung cancer. Patients with comorbid conditions, those with a history of major surgery, tuberculosis, or cancer, and those aged over 65 were excluded. All included patients received chemotherapy. Patients were divided into two groups: Those diagnosed through screening programs (16 patients) and those diagnosed based on symptoms (29 patients). All patients underwent VATS lobectomy or segmentectomy. Postoperative complications, 36-month survival rates, and causes of death were compared between the groups. Results The 36-month survival rate was higher in the screening group compared to the symptomatic group. Additionally, the recurrence rate was lower in the screening group. Among symptomatic patients, 3 presented with hemoptysis. Causes of death included respiratory failure, metastasis, and cardiovascular events. These findings suggest that early diagnosis through screening programs leads to better clinical outcomes. Conclusions Screening programs for lung cancer facilitate early diagnosis and treatment, resulting in improved survival rates and lower recurrence rates. The implementation and promotion of these programs could significantly enhance patient outcomes.

Patient factors associated with embolization or splenectomy within 30 days of initiating surveillance for splenic trauma.

Non-operative management of hemodynamically stable patients with splenic trauma has been recommended for more than 25 years, but in practice embolization and/or splenectomy (intervention) is often needed within the first 30 days. Identifying the risk factors associated with the need for intervention could support more individualized decision-making. We used data from the SPLASH randomized clinical trial, a comparison of outcomes of surveillance or embolization. 140 patients were randomized, 133 retained in the study (embolization n = 66; surveillance n = 67) and 103 screened and registered in the non-inclusion register. Multivariate Cox proportional hazards models with time-varying covariates were used to identify risk factors contributing to embolization and/or splenectomy within 30 days after initiating surveillance only for splenic trauma. 123 patients (median age, 30 [23; 48] years; 91 (74%) male) initially received non-operative management. At the day-30 visit, 34 (27.6%) patients had undergone an intervention (31 (25.2%) delayed embolization and 4 (3.3%) splenectomy). Multivariate analysis identified patients with OIS grade 4 or 5 splenic trauma (HR = 4.51 [2.06-9.88]) and (HR = 34.5 [6.84-174]); respectively) and splenic complications: arterial leak (HR = 1.80 [1.45-2.24]), pseudoaneurysm (HR = 1.22 [1.06-1.40]) and pseudocyst (HR = 1.41 [1.21-1.64]) to be independently associated with increased risk of need for an intervention within 30 days of initiating surveillance. Our study shows that more than 1 in 4 patients who received non-operative management needed embolization or splenectomy by day 30. Arterial leak, pseudoaneurysm, pseudocyst, and OIS grade 4 or 5 were independent risk factors linked to the need for an intervention. clinicaltrials.gov Identifier NCT02021396.

Statistical analyse of outdoor blast wave propagation in real environments

The propagation of outdoor blast waves is governed by numerous physical parameters, including source energy, terrain relief, ground nature, and atmospheric conditions. Among these, certain effects are deterministic and can be effectively modeled through numerical simulations. This research leverages the one-way Flhoward code, used with Arome meteorological data and IGN topography, to simulate the waveforms of blast waves originating from 300 kg explosions up to a distance of 20 km. Given the inherent randomness of the medium, these waveform signatures exhibit a high degree of uncertainty. To address this uncertainty, we introduce a metamodel based on polynomial chaos, designed to quantify the uncertainties. First, this study focuses on the validation of the code for accurately simulating waves above a relief. Subsequent steps of the study involve a comprehensive comparison of outcomes from direct simulations and metamodel-based simulations against measurements obtained from records of well-calibrated ground explosions. This comparison not only validates the effectiveness of the Flhoward code and the developed metamodel but also highlights the significance of considering the random nature of the medium. This research paves the way to a framework for understanding and anticipating the impact of such phenomena across varied outdoor environments.

Influence of Stroke-Onset Location on the Efficacy of Endovascular Thrombectomy: Comparison of Outcomes between In-Hospital versus Community-Onset Strokes.

Previous studies have suggested that patients experiencing an in-hospital stroke may face delays in treatment and worse outcomes compared with patients with community-onset strokes. However, most studies occurred when IV thrombolysis was the primary treatment. This study aimed to examine the outcomes of patients experiencing an in-hospital stroke in the endovascular thrombectomy era. This was a single-center retrospective cohort study of patients older than 18 years of age with acute ischemic stroke treated with endovascular thrombectomy within 12 hours of stroke onset from January 1, 2015, to April 30, 2021. Patients were classified into 2 groups: in-hospital strokes and community-onset strokes. We compared the time metrics of stroke care delivery, the rate of successful reperfusion, and functional outcome as scored using the mRS score at 90 days (favorable outcome was defined as mRS 0-2). Differences in proportions were assessed using the Fisher exact and χ2 tests as appropriate. For continuous variables, differences in medians between groups were evaluated using Mann-Whitney U tests. A total of 676 consecutive patients were included, with 69 (10%) comprising the in-hospital stroke group. Patients experiencing in-hospital stroke were more likely to have diabetes (36% versus 18%, P = .02) and less likely to receive thrombolysis (25% versus 68%, P < .001) than those in the community-onset stroke group, but they were otherwise similar. Patients with in-hospital stroke had significantly faster overall time metrics, most notably from stroke recognition to imaging (median, 70 [interquartile range, 38-141] minutes versus 121 [74-228] minutes, P < .001). Successful recanalization was achieved in >75% in both groups (P = .39), with a median NIHSS score at discharge of <4 (P = .18). The 90-day mRS was similar in both groups, with a trend toward higher in-hospital mortality in the in-hospital stroke group (P = .06). Patients with in-hospital stroke had shorter workflow delays to initiation of endovascular thrombectomy compared with their community counterparts but with a similar rate of successful recanalization and clinical outcomes. Most important, 90-day mortality and mRS scores were equivalent between in-hospital stroke and community-onset stroke groups.

Clinical Characteristics and Outcomes of Patients With COVID-19 Treated in Mayo Clinic’s Advanced Care at Home Program

Objectives Mayo Clinic’s hospital-at-home program, Advanced Care at Home (ACH), launched in 2020. While hospital-at-home literature reported safe and effective care for the general patient population and those with COVID, comparative outcomes between these two groups were unknown. The aim of this retrospective analysis was to compare the outcomes of COVID and non-COVID patients enrolled in ACH and evaluate if COVID patients can be safely treated in this setting. Methods Demographics, clinical characteristics, and safety outcomes were retrospectively analyzed to compare COVID and non-COVID patients discharged from ACH between November 2020 and May 2022. Patient characteristics analyzed included severity of illness (SOI) and risk of mortality (ROM), calculated using All Patient Refined Diagnosis Related Groups (APR-DRG). Hospitalization-specific variables included length of stay (LOS), escalation of care, and 30-day readmission rates. Results Of 1051 patients, 173 (16%) had COVID, and 878 (84%) were non-COVID patients. The average age in the COVID cohort was 66.6 (15.3) years, compared with 72.2 (14.0) in the non-COVID cohort. Extreme SOI was higher in the COVID group (43.3% versus 17.4%), as was extreme ROM (46.2% versus 16.2%), but LOS was shorter (5.7 versus 7 days). Escalation of care (7.5% in COVID cohort versus 8.4%) and 30-day readmission outcomes (9.2% for COVID patients versus 12.9%) were not statistically different between the groups. Conclusions Despite higher SOI and ROM, COVID patients had shorter LOS with outcomes that were not statistically different from non-COVID patients. COVID patients can be safely and efficiently cared for in ACH.

Comparison of clinical motor outcomes between unilateral pallidotomy versus subthalamotomy in patients with idiopathic Parkinson's Disease

Comparison of clinical motor outcomes between unilateral pallidotomy versus subthalamotomy in patients with idiopathic Parkinson's Disease

The impact of concurrent HIV-infection on women with vulvar cancer: Comparison of clinical characteristics and outcome.

HPV-related vulvar cancer is increasing in prevalence, especially in women living with HIV. Treatment of vulva cancer is based on evidence from HPV-independent cancers, which affect older women. The impact of HIV on vulvar cancer characteristics and treatment outcomes needs to be elucidated. A retrospective observational study compared the clinical characteristics, treatment, and outcomes of 92 HIV-positive and 131 HIV-negative women with vulvar cancer at our institution. Using descriptive statistics, HIV-positive and negative patients were compared and Cox regression models were tested for differences in mortality and recurrence. HIV-positive patients were 20 years younger than HIV-negative patients (p < 0.001). More than 50% of patients presented with advanced stage cancer, however this was independent of HIV-status. Although HIV infection was associated with poorer survival (p = 0.022); rates of cure (p = 0.933) and recurrence rates (p = 0.8) were similar in HIV-positive and negative women. Vulvar cancer occurs at a much younger age in women living with HIV. Awareness among HIV-positive women and health care providers would lead to diagnosis of vulvar cancer at an earlier stage. Treatment protocols for HPV-related vulvar cancer should not be altered due to HIV status and should take into consideration the young age of the patients.

Comparison of visual acuity outcome and choroidal thickness variation of intravitreal ranibizumab injection for myopic choroidal neovascularization with or without dome-shaped macula

BackgroundTo investigate the visual acuity outcome and choroid thickness (CT) change after intravitreal ranibizumab in highly myopic eyes with or without dome-shaped macula (DSM) in Chinese patients. MethodsThis retrospective, observative study included 80 treatment-naive eyes (80 patients), which received ranibizumab according to the 1+PRN protocol. The best corrective visual acuity (BCVA) and CT change were compared between eyes with or without DSM. ResultsThere was no significant difference between eyes with or without DSM in BCVA and central macular thickness (CMT). The recurrent rate was not different between the two groups during the first year of treatment. The CT was significantly thinner in eyes with DSM than in eyes without DSM before treatment (median 40.00um versus 71.00um), at 1 month after treatment (median 31.00um versus 65.50um), and in the last follow up (median, 32.00um versus 65.00um) (p = 0.0101). Axial length (AL) was longer in eyes with DSM than those without DSM (median, 29.17 mm versus 28.10 mm) before treatment, and in the last follow up (median, 29.44 mm versus 28.20 mm) (p = 0.0055). The CT was significantly correlated with AL (p < 0.0001). ConclusionsNo difference was found in visual outcome between eyes with or without DSM. The visual acuity significantly improved at 1 month after ranibizumab injection and it was recovery sooner in extrafoveal choroidal neovascularization (CNV) group than in subfoveal CNV group. The CT was thinner in eyes with DSM, which was significantly correlated with AL.

Moderate hypothermia circulatory arrest as a brain-protective strategy for type A aortic dissection.

Brain-protective strategies for acute type A aortic dissection (TAAD) remain controversial. Moderate hypothermia circulatory arrest (MHCA) without cerebral perfusion is not commonly used. However, we aimed to assess its safety and efficacy in 358 patients who underwent hemiarch replacement with MHCA for acute type A aortic dissection at our institution from August 2012 to August 2022. Clinical outcomes were compared according to circulatory arrest time [≤15 min (S group, n = 52) vs ≥16 min (L group, n = 306)]. The primary outcome was postoperative stroke. The S group had more older patients (72.5 vs 68.8 years; P = 0.04), a greater incidence of carotid artery malperfusion (21% vs 11%; P = 0.043) and a lower body mass index (21.7 vs 23.6 kg/m2; P < 0.01) and hemodynamic instability (3.8% vs 16%; P = 0.02) than the L group. The incidence of postoperative stroke (7.7% vs 12%; P = 0.33) and the rate of 30-day mortality (5.8% vs 6.5%; P = 0.83) did not significantly differ between groups. After adjusting for all potential confounding factors pre- and intraoperatively, there was no significant difference in postoperative outcomes between groups. MHCA alone for TAAD had comparable postoperative outcomes with circulatory arrest times under and over 15 min. However, longer arrest times were associated with a higher risk of stroke.

Laparoscopic versus open repair for peptic ulcer perforation: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials. Time to conclude!

The aim of this study was to investigate comparative outcomes of laparoscopic and open repair for peptic ulcer perforation (PUP). A PRISMA-compliant systematic review with a PROSPERO-registered protocol (registration number CRD42024529286) was conducted. All randomised controlled trials (RCTs) involving PUP patients managed by laparoscopic or open repair were identified and their risk of bias assessed. Outcome syntheses for perioperative mortality and morbidities, need for reoperation, procedure time and length of hospital stay were conducted using random-effects modelling to calculate risk ratios (RR) or mean difference (MD) with 95% confidence intervals (CI). Nine RCTs met the inclusion criteria, enrolling 670 patients of whom 317 were randomised to receive laparoscopic surgery and 353 were managed with open surgery. Laparoscopic repair of PUP significantly reduced mortality (RR 0.37, p = 0.03), total complications (RR 0.57, p = 0.0009), ileus (RR 0.43, p = 0.04), wound complications (RR 0.36, p < 0.0001) and length of hospital stay (MD -2.37, p = 0.0003) compared with the open approach. There were no significant differences in rate of postoperative leak (RR 2.00, 95% CI 0.74-5.41, p = 0.17), abdominal collection (RR 1.19, 95% CI 0.46-3.07, p = 0.72), sepsis (RR 1.17, 95% CI 0.39-3.52, p = 0.65), respiratory complications (RR 0.68, 95% CI 0.32-1.46, p = 0.32), reoperation (RR 1.74, 95% CI 0.57-5.30, p = 0.33) and operating time (MD 15.31, 95% CI -4.86 to 35.47, p = 0.14) between the two groups. Laparoscopic repair of PUP is associated with significantly lower mortality and morbidity and shorter length of stay compared with the open approach. The laparoscopic approach should be the management of choice subject to the existence of laparoscopic expertise.

A comparative study of single-stage bilateral vs. unilateral medial unicompartmental knee arthroplasty on complications, clinical outcomes, and costs.

This retrospective study aimed to evaluate the short-term recovery and cost-effectiveness of bilateral unicompartmental knee arthroplasty (UKA) compared to staged unilateral UKA. The study analyzed postoperative pain scores, medical costs, and complications in patients with knee osteoarthritis who underwent these procedures. A total of 226 patients who received either unilateral UKA (Group A, n = 170) or bilateral UKA (Group B, n = 56) using the mobile-bearing UKA were included in the study. Patient demographics, surgical details, postoperative pain scores, knee range of motion, length of hospital stay, self-controlled analgesic use, total medical costs, and complications were retrospectively collected from medical records. The demographic characteristics were comparable between the groups. Group B had a longer surgical time and higher medical costs than Group A. However, there were no significant differences in hospital stay, pain scores, or knee range of motion between the two groups. Complications were infrequent and not significantly different. Insert dislocation and loosening were the most common complications. Patient-controlled analgesia effectively reduced pain scores in Group A but not in Group B. Bilateral UKA does not significantly affect hospital stay, postoperative pain, or complications compared to unilateral UKA. Although bilateral UKA requires longer surgical time and incurs higher costs, it offers the potential benefit of reducing anesthesia-related complications and overall health insurance expenditures. This study recommends bilateral UKA as a suitable option for patients with bilateral knee osteoarthritis, given its comparable short-term outcomes and potential cost-saving advantages. III.

Redefining Surgical Boundaries for Obese Patients? Full Endoscopic Lumbar Discectomy Proves Equally Effective With Shorter Hospital Stay in Obese Patients.

This cohort study aims to evaluate the impact of obesity on the outcomes of full endoscopic lumbar discectomy (FELD) in patients with lumbar disc herniation. We conducted a retrospective analysis of 156 adult patients who underwent FELD for lumbar disc herniation from January 2015 to February 2023. Patients were divided into 3 groups: obese endoscopic (n = 71), obese open surgery (n = 31), and nonobese endoscopic (n = 54). Clinical outcomes were assessed using the visual analog scale for leg and back pain, the Oswestry Disability Index, and patient satisfaction rates. Operative time, hospital stay duration, and complication rates were also analyzed. No significant differences were observed in patient-reported outcome measures, operative time, or complication rates between obese and nonobese patients undergoing FELD. The mean operative time was longer in the endoscopic group compared with the open surgery group (70.2 vs 59.8 minutes), but the hospital stay was significantly shorter for endoscopic patients (1.7 vs 2.4 nights, P = 0.0006). Both obese and nonobese groups showed significant improvements in visual analog scale and Oswestry Disability Index scores at the final follow-up, with satisfaction rates of 85.7% in the endoscopic group reporting good to excellent outcomes. FELD is a viable and effective alternative to traditional open surgery for obese patients, offering comparable clinical outcomes and the added benefit of a shorter hospital stay. These findings suggest that obesity does not inherently affect surgical outcomes, underscoring the need for further research with larger sample sizes and longer follow-up periods. FELD offers a viable and effective surgical option for obese patients, with outcomes comparable to traditional surgery but with the added benefit of shorter hospital stays.

Primary ACL repair in a selected patient cohort: A prospective single cohort study

BackgroundAnterior cruciate ligament (ACL) tears are common knee injuries, particularly in physically active individuals. While ACL reconstruction (ACL-R) is the standard treatment, it has notable limitations. Recent interest in primary ACL repair offers a potential alternative, especially for specific tear types and patient demographics. PurposeTo evaluate the outcomes of primary ACL repair in a selected patient cohort with strict inclusion and exclusion criteria, focusing on the survival of the procedure, functional outcomes, and factors influencing success rates. MethodsThis prospective single cohort study included 61 patients who underwent primary ACL repair between June 2016 and June 2022. Patients were 50 years or younger, with recent ACL injuries and no previous knee surgeries or multiligament injuries. The primary outcomes were the survival of the repair beyond two years, measured by revision rates, and functional outcomes assessed using the Lysholm knee score, Tegner activity scale, and Lachmeter stability measurements. ResultsFifty-four patients completed a minimum follow-up of three years (average 49.6 months). The overall success rate was 82.2 %, with Sherman type 1 tears showing significantly fewer failures compared to type 2 (4.3 % vs. 31.8 %). The mean Lysholm score for successful repairs was 96, and the Tegner score dropped from a pre-injury average of 6 to 5. Adolescents had the highest failure rate (50 %), while other age groups showed better outcomes. The mean side-to-side difference in stability was 1.4 mm, favoring the control side. ConclusionPrimary ACL repair is a viable option for selected patients, particularly those with Sherman type 1 tears. While age and tear type significantly affect outcomes, the procedure shows promising results with high functional scores in successful repairs. Further research with larger cohorts and extended follow-ups is necessary to validate these findings and refine patient selection criteria. Primary ACL repair offers a less invasive alternative to ACL reconstruction, with potential for comparable outcome.

B-057 Evaluating the Use of Unconcentrated Urine for Protein Electrophoresis and Immunofixation: An Alternative Approach for Efficient Analysis

Abstract Background Protein electrophoresis is a widely employed technique for separating and analyzing proteins based on their charge and size. Traditionally, concentrated urine samples have been utilized to enhance protein detection sensitivity. However, this study explores the feasibility of using unconcentrated urine as an alternative sample type for protein electrophoresis (UEL) and immunofixation (UIF) to streamline the analysis process and reduce costs and turnaround time in clinical laboratories. It offers a more efficient and resource-friendly alternative. Methods Both UEL and UIF were performed on routinely ordered 80 urine specimens (random or 24 Hr.) for patient management and performed by both concentrated (X40) by Helena and unconcentrated using Sebia (HYDRAGEL 9IF gels using HYDRAGEL BJ dynamic mask procedure. The electrophoretic patterns obtained from unconcentrated urine were compared with those from concentrated urine. Various electrophoretic parameters, including resolution, sensitivity, and reproducibility, were evaluated to determine the reliability of unconcentrated urine in protein electrophoresis. In addition, retrospective analysis was performed before and after implementation on all urine specimens ordered to analyze if there were any differences in the monoclonal band distributions in the population. Results All the protein concentrations were correlated well with 95-100% agreement between the methods (Figure 1) clear separation of protein fractions. Serial dilution studies of monoclonal band analyses showed that these bands can be detected at 1.25 mg/dL using an unconcentrated method. Retrospective analysis of patient data before and after the implementation of the new method shows no differences in the identification of monoclonal proteins (Helena [69 of 872 total patients tested (8.0%)] vs. Sebia [90/800 (11.0%)]. Conclusions These results indicate that unconcentrated urine can be successfully utilized for UEL and UIF with comparable outcomes to traditional concentrated samples. Utilizing unconcentrated urine simplifies the sample preparation process and presents a promising alternative.

Fix or Replace? Comparable Outcomes with Internal Fixation and Distal Femoral Replacement for Periprosthetic Fractures above Total Knee Arthroplasty

IntroductionThe optimal treatment for periprosthetic fracture (PPfx) around total knee arthroplasty (TKA) remains a topic of debate. Due to its low incidence, comparative studies analyzing arthroplasty and fixation are lacking in the literature. The purpose of this study was to compare the outcomes of distal femoral replacement (DFR) and open reduction and internal fixation (ORIF) for distal femur PPfx. MethodsWe reviewed a consecutive series of 99 patients who underwent DFR (n = 54) or ORIF (n = 45) for distal femur PPfx. The indications for DFR were reviewed. Fractures were classified based on their relation to the implant using the Su classification. The primary outcome was re-revision, while secondary endpoints included inpatient complications, mortality within the first year, and mechanical complications such as loosening and non-union. ResultsType 2 fractures were the most prevalent type in both groups (DFR 37 versus ORIF 48.9%), while Type 1 fractures were more commonly treated with ORIF (35.6 versus 16.7%) and Type 3 with DFR (46.3 versus 15.6%) (P = 0.003). The preferred techniques in the ORIF group were plate osteosynthesis (66.7%) and retrograde nailing (31.1%). At a mean follow-up of 4.2 years (range, 1 to 14.1), DFR and ORIF did not demonstrate any difference in revision rates (13 versus 24.4%, P = 0.140) or mortality (3.7 versus 4.4%, P = 0.887). However, more mechanical complications were noted in the ORIF group (22.2 versus 7.4%, P = 0.035). ConclusionBoth distal femoral replacement and open reduction and internal fixation have comparable revision rates, complications, and clinical outcomes when used in supracondylar periprosthetic distal femur fractures. Longer-term studies are needed to assess DFR survivorship as well as outcomes of newer trauma techniques such as nail-plate combinations.

Comparison of outcomes between single-port and multiport retroperitoneal robotic partial nephrectomy

IntroductionSingle-port (SP) robotic surgical system performs well in small anatomical spaces, which makes it suitable for retroperitoneal robotic partial nephrectomy (RPN). However, there is limited evidence comparing the safety and feasibility of SP RPN to multiport (MP) RPN. To address this gap in evidence, we sought to analyze and compare the safety of retroperitoneal RPN between SP and MP approaches. MethodsThis is a retrospective cohort study using data from the Single Port Advanced Research Consortium (SPARC) and a multicenter database of patients who underwent retroperitoneal RPN using either SP or MP between 2017 and 2023. Baseline, perioperative, and postoperative data were compared using t-tests, Mann-Whitney U test, χ2 test, and Fisher exact test. Multivariable analyses were conducted using robust and Poisson regressions. ResultsA total of 286 patients (SP RPN, n = 86 [30%]; MP RPN, n = 200 [70%]) underwent retroperitoneal RPN. R.E.N.A.L nephrometry score and tumor location were significantly different between the 2 groups. Notably, the ischemia time was significantly shorter in the MP group (16 vs. SP, 22 minutes, P < 0.001). Adjusting for baseline characteristics, the ischemia time was approximately 7.89 minutes longer for patients in the SP group compared to the MP group, on average (95% CI: 5.87, 9.92; P < 0.001). No significant differences were observed in operative time, EBL, blood transfusion, conversion rates, LOS, PSM, and overall 30-day postoperative complications between the 2 groups. ConclusionOur study shows that retroperitoneal SP and MP RPN have comparable perioperative and postoperative outcomes, except for the longer ischemia time in the SP platform. SP RPN is a safe and viable alternative; however, further research is needed to explore its potential benefits, cost-effectiveness, and long-term oncologic outcomes.

Evaluating the Effectiveness of a Structural Allograft in Medial Open Wedge High Tibial Osteotomy in Patients With and Without a Lateral Hinge Fracture.

A lateral hinge fracture is a common complication in medial open wedge high tibial osteotomy (MOWHTO) and is associated with delayed union or nonunion. A comparison of outcomes between patients with or without a lateral hinge fracture after MOWHTO with a structural allograft has not been investigated. To validate the outcomes of MOWHTO with a structural allograft, especially in the presence of a lateral hinge fracture. Case series; Level of evidence, 4. We conducted a single-surgeon cohort study at a tertiary referral hospital between April 2017 and August 2022 and included patients who had undergone MOWHTO with a structural allograft for isolated medial compartment osteoarthritis with genu varum. We compared the incidence of delayed union or nonunion events and functional scores between patients with a lateral hinge fracture and those without using the Fisher exact test and independent t test. A total of 88 MOWHTO procedures (77 patients) were analyzed. The overall incidence of lateral hinge fractures was 29.5% (n = 26), including type I (n = 20 [22.7%]) and type II (n = 6 [6.8%]). Notably, 42.3% (n = 11) of these fractures had not been detected intraoperatively but during the follow-up visits. The overall Knee Society Score (KSS), Knee Society Score-Function (KSS-F), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were 90.0 ± 10.0, 93.4 ± 10.8, and 93.8 ± 7.1 points, respectively. None of the patients had delayed union or nonunion, and none underwent a reoperation because of bony union problems. The functional scores (KSS, KSS-F, and WOMAC) were not different between patients who had a lateral hinge fracture and those who did not (P > .05). The routine use of a structural allograft was associated with satisfactory outcomes after MOWHTO, regardless of whether there was a lateral hinge fracture.

Cohort profile: Understanding the influence of early life environments and health and social service system contacts over time and across generations through the Western Australian Aboriginal Child Health Survey (WAACHS) Linked Data Study

PurposeDespite the volume of accumulating knowledge from prospective Aboriginal cohort studies, longitudinal data describing developmental trajectories in health and well-being is limited. The linkage of child and carer cohorts from...

Comparative analysis of medial pivot vs. posterior stabilized total knee arthroplasty in patients with valgus deformed osteoarthritic knees: a retrospective cohort study.

Total knee arthroplasty (TKA) is highly effective for end-stage knee osteoarthritis, providing long-term benefits and anticipated increased prevalence. The study compares Medial Pivot TKA's (MP-TKA) historical success for varus deformities with recent findings suggesting comparable outcomes for valgus deformities. Despite prevalent use of Posterior Stabilized TKA (PS-TKA) for valgus deformities, this research explores the unexplored comparative efficacy of MP-TKA vs. PS-TKA in knee osteoarthritis patients with valgus deformity. This single-centrecohort study focused on 57 knees in 53 patients undergoing TKA for knee osteoarthritis with valgus deformity. Conducted between January 2013 and April 2021, the study compared MP-TKA and PS-TKA. Surgeries adhered to a medial parapatellar approach and modified gap technique, with perioperative interventions for pain, bleeding, and swelling. Outcome measurements included knee joint range of motion, radiographic evaluation, patients-reported outcomes, operative time, blood laboratory tests, estimated blood loss, and postoperative adverse events, and analyzed between the two groups. Postoperative hip-knee-ankle angles showed no significant difference between MP-TKA and PS-TKA. The pie crust technique was similarly used in both groups, and deformity correction showed no significant difference. Range of motion and clinical outcomes, measured by WOMAC and JOA scores, were comparable postoperatively. MP-TKA had a shorter surgical duration (p = 0.01), and PS-TKA exhibited higher estimated blood loss (p = 0.01) without significant complications in either group. This pioneering study compares the outcomes of MP TKA and PS TKA in patients with valgus-deformed osteoarthritic knees. Compared to PS TKA, MP TKA shows a prolonged operative duration and increased blood loss, likely due to the requirement for patellar replacement. However, postoperative range of motion and clinical outcomes are similar. Both groups exhibit favorable midterm clinical results, supporting the viability of MP TKA for valgus deformed knees. The study, consistent in surgical approach, highlights MP TKA's effectiveness for valgus deformities.

Predicting Which Newborns Will Benefit from Early Peritoneal Dialysis following Cardiac Surgery: A Quest for Precision Medicine with Comparative Outcomes

Predicting Which Newborns Will Benefit from Early Peritoneal Dialysis following Cardiac Surgery: A Quest for Precision Medicine with Comparative Outcomes