Revision Strategies Research Articles

Isolated aseptic loosening in total knee arthroplasty: a comprehensive 10-year review of partial vs. total component revisions

BackgroundIn total knee arthroplasty (TKA), isolated aseptic loosening (IAL) requires the replacement of prosthetic components, with ongoing debate regarding the effectiveness of partial component revision (PCR) compared to total component revision (TCR). This study aims to compare implant survival and surgical outcomes between PCR and TCR in the context of IAL.MethodsThis retrospective study analyzed data from 285 patients who underwent revision TKA for IAL between January 2000 and December 2013. After applying exclusion criteria, 112 patients were included in the analysis—60 undergoing TCR and 52 undergoing PCR.ResultsPCR was associated with shorter operative times and hospital stays compared to TCR, alongside significant differences in the choice of revision prostheses. Although the prosthesis failure rates were comparable between the groups (13.6% for TCR and 18.33% for PCR), significant risk factors for failure were identified, including a canal filling ratio (CFR) below 0.8 and a discrepancy over 0.2 between CFR views. However, no significant differences in overall survivorship were observed between the groups.ConclusionsBoth PCR and TCR provide similar survival rates and clinical outcomes for managing IAL in TKA. PCR provides advantages in terms of surgical efficiency and patient recovery, while reducing the need for more constrained prosthetic solutions. The study identifies CFR as a critical predictor of prosthesis failure, highlighting the importance of detailed preoperative planning and implant selection. These findings contribute valuable insights for improving revision strategies in IAL, enhancing surgical outcomes in TKA.Level of evidenceIII.

Effect of students’ seminar as a revision strategy in biochemistry among I MBBS students in a medical college in Tamil Nadu

Background: Small group teaching is one of the components of competency-based medical education which was implemented in 2019 by NMC. Seminar is one of the methods of small group teaching which increases the engagement of students, self-directed learning, communication skills, and peer discussion. Aims and Objectives: The present idea is to study the effect of students’ seminar as a revision strategy in Biochemistry among I MBBS students. Materials and Methods: After obtaining the IEC approval, I MBBS students who are 250 in number will be divided into small groups. Each group will be given a particular seminar topic. All the students in the particular group will be instructed to present the topic on random basis. A total of 15 seminars will be conducted on particular topics. Pre-tests and post-tests (immediately after the seminar) will be conducted after the seminars along with pre-test and post-test questionnaires will be obtained and collated to understand how far the student’s acceptance of students’ seminar and its effectiveness. Results: Our study results showed that that there is an increase in the percentage of marks in the post-evaluation and also more than 70% of the students responded positively to most of the queries in the feedback questionnaire. Conclusion: Our study results showed that there is an increase in the percentage of marks in the post-evaluation and also more than 70% of the students responded positively to most of the queries in the feedback questionnaire.

Modified Genetic Algorithm for Efficient High-Utility Itemset Mining

In pattern mining, high-utility itemset mining (HUIM) is useful for discovering high-utility patterns. The study of HUIM using heuristic techniques reflects issues in producing better offspring. It is ineffective in terms of search space organization, population diversity, and utility calculation, which impact runtime and accuracy. It is observed that very few researchers have experimented with genetic algorithm (GA) and are still facing the same issues as mentioned before. To overcome these problems, a novel approach is proposed for HUIM using modified GA and optimized local search (HUIM-MGALS) with six potential contributions. First is linking the utility with the Bitmap dataset to reduce utility access time, leading to effective search space organization. Second, HUIM-MGALS employs a fitness scaling strategy to avoid redundancy. Third, a high-utility itemset (HUI) revision strategy is employed to explore significant HUIs. Modified population diversity maintenance strategy and iterative crossover help to preserve significant HUIs and improve search capability as fourth and fifth contributions. Sixth, the use of multiple mutations refines the wasted individuals to boost accuracy. Extensive experimentation showed that HUIM-MGALS significantly outperforms the presented algorithms, up to 8.6 times faster. It also demonstrates superior HUI discovery capabilities for both sparse and dense datasets. This is supported by the modified population diversity maintenance strategy, which is proved to be the most impactful modification for HUI discovery in HUIM-MGALS.

Junior High School Written Work Fluent and Accurate

The present study determined the written language performance of junior high school students at Bulan National High School S. Y.2023 - 2024. The study utilized a mixed methods approach, combining quantitative and qualitative methods to assess the students' written language proficiency. Quantitative data were collected using rubrics to evaluate fluency and accuracy, while qualitative data were obtained through content analysis of the students' essays. The findings revealed that the students' performance in terms of fluency and accuracy varied, with areas of improvement identified in both aspects. Difficulties encountered by the participants included challenges in maintaining coherence and organization in their writing, as well as issues related to spelling accuracy and punctuation and capitalization usage. Based on the findings, an action plan titled "Enhancing Written Language Skills Program" was proposed to address these challenges and improve the students' writing abilities. The study's conclusions indicated that while the average performance level of the junior high school students in terms of fluency and accuracy met the set standards, there were variations in individual performance levels. The participants faced difficulties in fluency and accuracy, including challenges related to content fluency, organization of ideas, spelling accuracy, and proper punctuation and capitalization usage. To address these challenges, the study recommended differentiated instruction, explicit instruction on effective writing components, targeted practice activities, self - editing and revision strategies, a comprehensive curriculum integrating explicit instruction and authentic writing tasks, professional development for teachers, formative assessments for progress monitoring, fostering a supportive writing environment, and utilizing technology resources. In addition to the recommendations from the study, further research was recommended to investigate the effectiveness of different instructional strategies in improving students' writing skills. This research could compare explicit instruction with other approaches, such as inquiry - based learning or project - based learning, to determine their impact on fluency, coherence, accuracy, and organization. Conducting such research would provide valuable insights and evidence - based recommendations for educators to enhance their instructional practices and support students' development in writing with fluency and accuracy.

One-Stage Versus Two-Stage Revision Surgery for Periprosthetic Hip Infection: An Updated Systematic Review and Meta-Analysis of Clinical Outcomes

Introduction: The primary objective of this meta-analysis was to evaluate and compare the functional outcomes, postoperative reinfection rates, and complication rates in patients undergoing one-stage versus two-stage surgical revision for periprosthetic hip infection. Methods: The study population included adult patients who had undergone revision hip arthroplasty. Comparative studies have compared two-stage and one-stage revision strategies. Searches were conducted using the major databases. Review Manager software was used to estimate the effects. A sensitivity analysis was also conducted. Results: Nine cohort studies including 2,502 hips were included. The success rate did not show significant differences between the groups (odds ratio [OR] 0.42, 95% confidence interval 0.05 to 3.37). No difference was noted in reinfection (OR 0.81, 95% CI 0.56-1.19). Life quality per Harris Hip Score was higher for one-stage revision strategies (mean difference [MD] 9.00, 95% CI 2.23-15.78). No differences were noted in mortality, aseptic loosening, or revision rates. Age (MD 2.32, 95% CI 1.34-3.29) and body mass index (BMI) (MD 1.88, 95% CI 0.38-3.38) were lower in the two-stage group. Sinus tract presence was higher in the one-stage group (OR 1.44, 95% CI 1.05-1.95). Paprosky I acetabulum was higher in the one-stage group, and Paprosky III was higher in the two-stage group. Conclusions: The results did not demonstrate notable clinical differences between one-stage and two-stage hip arthroplasties, regardless of the treated microorganism. However, the quality of life may be somewhat better in the one-stage group. Age, body mass index, and Paprosky classification are factors that influence procedure selection.

Periprocedural clinical outcomes of revision hip arthroplasty: a multi-centric comparison of current strategies based on the NSQIP.

Recent projections suggest a substantial rise in demand for revision total hip arthroplasties, emphasizing the need for optimized perioperative care. Various revision techniques, such as isolated acetabular or femoral component revisions and total replacements, have garnered attention. Further research is needed to establish the most effective strategies for improving clinical outcomes. This retrospective analysis utilized data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use File from 2016 to 2021. The study aimed to compare clinical characteristics and 30-day outcomes among patients undergoing combined acetabular and femoral (A + F) revision, acetabulum-only (A) revision, and femoral side-only (F) revision surgeries. The analysis of 18,888 patients revealed crucial differences in preoperative and postoperative outcomes among various revision strategies. Specifically, there were notable variations in patient demographics, comorbidities, and emergency procedures. Postoperative data showed distinct rates of mortality, complications, and readmissions across the groups. Notably, femoral component revisions were associated with increased risks of mortality, transfusion, and urinary tract infections, underscoring the need for careful evaluation and consideration when opting for this revision approach. The study's significance lies in its extensive patient cohort and multifaceted evaluation of revision strategies. Although consensus is lacking on single-component revisions, targeting the acetabulum component appears relatively safer. Continued research and individualized evaluations are crucial for refining revision strategies and optimizing outcomes in THA revisions.

A Registry Study on Acetabular Revisions Using Jumbo Cups: Do We Really Need a More Complex Revision Strategy?

BackgroundThe increasing global performance of total hip arthroplasty (THA) has led to a rise in revision surgeries, primarily due to cup failure, with aseptic loosening and periprosthetic infection being common causes. Various techniques and implants, including jumbo cups (JCs), manage residual bone loss post-cup removal, facilitating enhanced surface area for improved host bone contact, and osteointegration. The purpose of the study was to determine the outcomes of acetabular revision arthroplasty using JC implants over a 20-year follow-up period by reporting overall survivorships, complications leading to re-revision, and surgical strategies in re-revision. MethodsA cohort study based on a large regional registry was conducted, examining revision THA surgeries utilizing JCs between 2000 and 2020. The study included all the revision acetabular procedures performed with cementless JCs, identified with a diameter ≥ 62 millimeters (mm) in women or ≥ 66 mm in men. All iliac fixation cups were excluded. Data on demographics, revision surgery indications, components, fixation types, causes of failure, and reintervention strategies were collected and analyzed. A total of 541 JCs implanted from January 2000 to December 2020 were evaluated. The most common revision indications were “cup aseptic loosening” (54.5%) and “total aseptic loosening,” which included both the cup and stem (32%). ResultsThe JC survival rates were 92.5% at 5 years, 85.8% at 10 years, and 81.5% at 15 years. Among the 70 failures, the main causes were “cup aseptic loosening” (40%), “total aseptic loosening” (17.1%), and “septic loosening” (12.8%). Revisions primarily involved acetabular cup revision surgery (54 cases), component explantation (11 cases), or insert or head revision (five cases). ConclusionsThis registry-based study of JCs in revision THA demonstrates excellent 15-year survival rates and acceptable failure rates. It supports JCs as a viable option, offering relative surgical simplicity compared to alternatives like antiprotrusion cages, bone grafts, and augments.

To revise or not to revise? This is the question

AbstractBuy and hold and periodical revisions are two competing investment strategies. Revising to the optimal one-period investment weights seemingly dominates the buy-and-hold strategy with random and uncontrolled investment weights determined by asset price changes. This intuition is misleading as both investment strategies are theoretically included in the risk aversion efficient set. Considering only economically relevant preferences, with stocks-bonds portfolios, both strategies are empirically included in the risk aversion efficient set as long as the investment horizon is shorter than 20 years. However, for an investment horizon longer than twenty years, the buy and hold strategy empirically dominates the revision strategy by Almost First-degree Stochastic Dominance ($$AFSD$$ AFSD ) rule, namely by all economically relevant utility functions. When the horizon is indefinitely long, holding only stocks dominates the stock–bond portfolios of both the B&H(S) and the RV(S). However, this theoretical result may be practically irrelevant for most investors with a horizon shorter than 20 years.

Analysis of Failed Atlantoaxial Reduction: Causes of Failure and Strategies for Revision.

The craniovertebral junction (CVJ) presents intricate anatomical challenges. In severe or irreducible malformations, complications such as reduction loss and fixation failure may occur, necessitating revision surgery. The posterior facet joint distraction and fusion (PFDF) technique, offers a solely posterior approach for revisions. Hence, we delineate varied revision scenarios, proposing surgical strategies and technical details to enhance outcomes and mitigate risks, thereby enriching the neurosurgical community's repertoire. This was a retrospective cohort study, analyzed patient data from Xuanwu Hospital, between 2017 to 2023. All patients had a history of surgical treatment for CVJ malformations, and experienced failure or loss of reduction. The distance from the odontoid process tip to the Chamberlain's line (DCL), the atlantodental interval (ADI), clivus-canal angle, cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx were used for radiographic assessment. Japanese Orthopaedic Association (JOA) scores and SF-12 scores were used for clinical assessment. Independent sample t-tests were employed. A significance level of p < 0.05 indicates statistically significant differences. We analyzed data from 35 patients. For patients who underwent PFDF, the postoperative DCL, ADI, and clivus-canal angle significantly improved. For all patients, the postoperative cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx all demonstrated significant improvement, indicating the relief of neural compression. All patients showed significant improvement in both symptoms and clinical assessments. Severe atlantoaxial joint locking or ligament contracting are the fundamental cause of reduction and fixation failure. Anterior odontoidectomy is indicated for patients with robust bony fusion of the atlantoaxial joint in an unreduced position. The PFDF technique is safe and effective for patients with incomplete atlantoaxial bony fusion. Preoperative assessment of surgical feasibility and vertebral artery status ensures surgical safety and efficacy.

Artificial urinary sphincter: recent developments and the way forward.

The AMS 800 has dominated the treatment of postprostatectomy urinary incontinence (PPUI) due to intrinsic sphincter deficiency (ISD) for five decades. A narrative review from June 2022 to June 2024 was conducted using 'artificial urinary sphincter' (AUS) MeSH terms in Embase. We extracted information on innovative AUS, randomized controlled trials (RCTs) or prospective studies, and systematic reviews. We evaluated the latest guidelines and consensus and analyzed current trends to discuss options for advancing AUS practices. Of 465 papers identified, 320 were excluded (irrelevant, duplicates, non-AUS devices, non-English, veterinary), and 145 were reviewed, with 24 selected: seven on novel AUS in development, 7 with higher-level evidence (1 RCT, 1 prospective, 4 systematic reviews, 1 nonsystematic review), and 9 retrospective relevant studies [pressure regulating balloon (PRB), revision strategies, radiotherapy history, manual dexterity/cognition, transscrotal vs. transperineal approach]. The final paper summarized current guidelines from Asia & Pacific on AUS. In the past 2 years, six novel AUS have emerged, two female RCTs are ongoing, the SATURN study published its 1-year outcomes, and four systematic reviews on female AUS were conducted. These findings enhance evidence levels and position novel AUS to challenge the Gold Standard.

A Pilot Study on the Drug Price Revision Strategy in Japan: A Comparison Among Fiscal Years 2018, 2020, and 2022

Objective: Japan has resumed its health technology assessment to decide how to reduce high-cost drug prices. While drug price rules in Japan are comprehensive, they do not necessarily capture differences in product characteristics. This study examined the drug price revision strategy in Japan using migraine treatment with triptans as an example. Cost data from fiscal years (FY) 2018, 2020, and 2022 were utilized. Methods: A cost-utility analysis was conducted from the perspective of healthcare payers, focusing on Japanese patients aged over 18 years experiencing migraines. The study employed a base-case model with probabilities derived from a network meta-analysis. Direct costs included medical and drug costs. Effectiveness was assessed using the European Quality of Life 5-dimensions—3-level questionnaire. Deterministic and probabilistic sensitivity analyses were conducted to examine the level of uncertainty. Results: In FY2018, sumatriptan and eletriptan were cost-effective; however, the other triptans were dominated by sumatriptan. In FY2020, sumatriptan and eletriptan were cost-effective, and rizatriptan was extended-dominated; nevertheless, the other triptans were dominated by sumatriptan. In FY2022, naratriptan and eletriptan were cost-effective; however, the other triptans were dominated by naratriptan. The hierarchy of triptan strategies varied in each fiscal year. Conclusions: This study provides valuable insights into the drug price revision strategy in Japan. The variations could be problematic because in Japan, formulary management of triptans, for example, those for migraine, may face revaluation every other year. Discussions regarding this issue will be further explored in the future.

The Microbiology of Knee Prosthetic Joint Infection and its Influence on Persistent Infection.

Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a severe complication causing a significant burden. The study aims were to establish the epidemiology of microorganisms in TKA PJI, the rate of persistent infection requiring further surgery, and the risk factors for this. Microbiological specimens between June 2002 and March 2017 at five regional hospital sites were identified with revision TKA procedures in the National Joint Replacement Registry. The time between procedures, type of revision strategy, and any subsequent further revision operations were collected. At minimum 2-year follow-up, 174 revision TKA were identified, with a mean patient age of 69 ± 11 years. A broad range of pathogens were identified. Fifty cases (29%) had persistent infection requiring at least one further operative procedure, 13 cases required 3 or more. Coagulase-negative Staphylococcus species (CNS) was seen most with failed surgery, polymicrobial infections also posing a significant risk factor. The best chance of a successful PJI surgical strategy was < 12 months from primary TKA, with the greatest risk between 3 and 5 years (p < 0.05). Younger age significantly increased the risk of further surgery (p < 0.05). Management varied; 103 (59%) debridement, antibiotic therapy and implant retention, with further surgery in 29%; 45 (17%) single-stage revision, with further surgery in 13%; and 26 (15%) two-stage revision, with further surgery in 12%. This study presents the most common causative pathogens for PJI in TKA, and the high rate of persistent infection after initial revision surgery. Risk factors for persistent infection and further revision surgery were polymicrobial and CNS infections, patients who presented between 3 and 5 years following primary TKA, and younger age. This study therefore raises important risk factors and areas for future research to reduce the burden of multiple operations after PJI.

A Practical Approach to Integrating a Telehealth Course and Health Informatics Skills Into a Curriculum for Advanced-Level Nursing Students.

Telemedicine and health informatics are a common aspect of patient care delivery in the United States. Graduate-level nursing students must be knowledgeable of telehealth and health informatics prior to entering the workforce as an advanced practice nurse. Nursing educators must provide educational opportunities within the curriculum that focus on telehealth and health informatics concepts that align with competencies. The Essentials: Core Competencies for Professional Nursing Education includes a new Domain #8 called, "Informatics and Healthcare Technologies," where five key subdomains of this competency are defined. This article describes the college's approach to incorporating telehealth and health informatics into the graduate-level curriculum and the associated alignment to the 2022 Essentials. Faculty professional development and course revision strategies improved the infrastructure for teaching telehealth and health informatics. The new Domain, #8, Informatics and Healthcare Technologies, can be successfully infused into the DNP curriculum with student engagement. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Revision total elbow arthroplasty: a primer for exam candidates

Total elbow arthroplasty (TEA) has a relatively high revision rate compared to conventional joint arthroplasties (4–7% at 5 years). The cause for revision is most commonly implant loosening. A thorough work-up with history, examination, bloods, radiographs and joint tissue or fluid samples are all required to rule out peri-prosthetic infection. Patient factors and soft tissue management must be considered before revising a TEA to ensure the best outcome and longevity of the revised implant. Surgical strategies for TEA revision include single or two-stage revision, bearing exchange, bone windows and strut grafts.

Study on the hydraulic turbine modeling method based on IGSA-NN revision strategy

Abstract With the further increase of renewable energy such as wind power and photovoltaic in the power grid, the hydraulic turbine regulating system (HTRS) faces enormous challenges. As simulation modeling is the basis for studying the optimal control of HTRS, it is crucial to establish a high-precision model of HTRS. As the core component of the HTRS, the hydro-turbine contains extremely complex nonlinearity, which model accuracy directly affects the accuracy of the HTRS simulation platform. However, current modeling methods have certain disadvantages such as large modeling errors and making the structure of the HTRS simulation platform more complex. Therefore, this paper proposes a data modification strategy (IGSA-NN) based on the BP neural network (BPNN) and an improved gravity search algorithm (IGSA) and then achieves high-precision modeling of the hydro-turbine combining the BPNN and actual operation data. Finally, the accuracy of the hydro-turbine model is verified by the actual operation data, and the method to build the simulation platform of the HTRS which contains both real and virtual components is given. The research results have a certain guiding significance for hydro-turbine modeling.

Revision Strategy for Proximal Junctional Failure: Combined Effect of Proximal Extension and Focal Correction.

Retrospective review of a prospectively-collected multicenter database. The objective of this study was to determine optimal strategies in terms of focal angular correction and length of proximal extension during revision for PJF. 134 patients requiring proximal extension for PJF were analyzed in this study. The correlation between amount of proximal junctional angle (PJA) reduction and recurrence of proximal junctional kyphosis (PJK) and/or PJF was investigated. Following stratification by the degree of PJK correction and the numbers of levels extended proximally, rates of radiographic PJK (PJA >28° & ΔPJA >22°), and recurrent surgery for PJF were reported. Before revision, mean PJA was 27.6° ± 14.6°. Mean number of levels extended was 6.0 ± 3.3. Average PJA reduction was 18.8° ± 18.9°. A correlation between the degree of PJA reduction and rate of recurrent PJK was observed (r = -.222). Recurrent radiographic PJK (0%) and clinical PJF (4.5%) were rare in patients undergoing extension ≥8 levels, regardless of angular correction. Patients with small reductions (<5°) and small extensions (<4 levels) experienced moderate rates of recurrent PJK (19.1%) and PJF (9.5%). Patients with large reductions (>30°) and extensions <8 levels had the highest rate of recurrent PJK (31.8%) and PJF (16.0%). While the degree of focal PJK correction must be determined by the treating surgeon based upon clinical goals, recurrent PJK may be minimized by limiting reduction to <30°. If larger PJA correction is required, more extensive proximal fusion constructs may mitigate recurrent PJK/PJF rates.

Microbiological acceptance criteria, specifications of herbal drugs and herbal drug preparations in various pharmacopoeias: a global scenario.

A pharmacopoeia is a compendium of guidelines and criteria for drug quality. It was established by a national or regional entity and has legal significance. This applies to administration of drugs in a particular nation or region. In this study, the differences and similarities of microbiological acceptance criteria, specifications for microbial enumeration of herbal drugs and herbal drug preparations in 14 national and international pharmacopeias were investigated. It was found that 12 pharmacopeias have given separate microbial limits for total aerobic microbial count (TAMC) and total yeast and mold count (TYMC), and a list of specified microorganisms for which acceptance criteria are defined. However, similarities were noticed in Ph.Eur, Ph. Helv and, BP. Salmonella, and Escherichia coli are the most common pathogens specified for herbal preparations in which boiling water is added prior to use and for internal use in all Pharmacopoeias because they serve as indicators of potential contamination. From this study, it can be concluded that the differences in microbial limit tests and their acceptance criteria as specified in the various pharmacopoeias need to be harmonized. It will become a more convenient option for global drug manufacturers to import/export herbal drugs, and this would also eliminate the burden of performing various analytical methods and comply with different microbial acceptance criteria set by various pharmacopoeias. The comparative data obtained from this study will be used to develop strategies for revisions of pharmacopoeias in a harmonized manner with respect to microbiological acceptance criteria, specifications for microbial enumeration of herbal drugs and herbal drug preparations.

Spinal Cord Stimulator Paddle Lead Revision and Replacement for Misplaced or Displaced Electrodes

ObjectivesSpinal cord stimulators (SCS) are commonly implanted via a laminotomy or laminectomy. Revision surgery may be necessary in instances of hardware failure or loss of efficacy. It is uncommon for leads to have been initially misplaced in a suboptimal position, and revision in these cases necessitates additional dissection for appropriate repositioning. Accordingly, there is concern with a more extensive revision for a potentially higher risk of associated complications. This study aims to describe a series of patients with failed paddle SCS electrodes due to misplacement who underwent revision and replacement. MethodsPatients who underwent SCS paddle replacement for misplaced paddles between 2021 and 2023 were identified. Medical charts were reviewed for demographic data, operative details, and incidence of complications. ResultsSixteen patients underwent thoracic SCS paddle revision and replacement. The mean age was 59.6±12.6 years, with 11 females and 5 males. Misplaced paddles were too lateral (n=12), too high (n=2), or incompletely within the epidural space (n=2). The mean duration from initial implantation to revision surgery was 44.8±47.5 months. The mean operative duration was 126.1±26.9 minutes, and all patients required a “skip” laminectomy or laminotomy. No complications were encountered. The mean length of follow-up was 18.4±7.3 months. Mean preoperative pain intensity was 7.9±1.5, and at last follow-up was 3.6±1.7 (p<0.001). All but one patient continued to use their device in follow-up. ConclusionThe revision and replacement of misplaced paddle SCS electrodes is a feasible and durable revision strategy, even in long-term implants with extensive scarring.

Perceptions and use of evidence-based revision methods among undergraduate medical students.

To assess awareness, perceptions and use related to evidence-based revision methods by undergraduate medical students. The descriptive cross-sectional study was conducted in three medical colleges of Rawalpindi, Islamabad, Pakistan, from December 01, 2019, to January 31, 2020, after approval from the ethics review committee of Army Medical College, Rawalpindi. The sample comprised undergraduate medical students of either gender. Data was collected online using a 10-item standardised questionnaire. Students were asked about the revision methods they used routinely and their perceptions of conventional and evidence-based revision methods. Data was analysed using SPSS 23. Of the total 136 respondents, 92(67%) were females and 44(32.3%) were male students. The response from preclinical and clinical years was 67 (50.7%) and 69(49.2%), respectively. Highlighting was the most widely used revision method among students (70 (51%) students), followed by re-reading important points (65 (47.7%) students). 126 (92%) students had the opinion that conventional revision methods were effective learning tools. Only 52 (38.2%) students were aware of the term 'evidence-based revision methods'. Digital tools based on principles of evidence-based revision were used by a minority of students which included use of online question banks by 21 (15.4%) students, osmosis by 40 (29.4%) students, sketchy pharma by 35 (25%)students, flashcards by 19 (14%) and picmonic by only 3 (2.2%). More than 114 (80%) students responded that they wanted evidence-based revision methods to be incorporated into curriculum, and 116 (85%) students said they would like to have a workshop on these techniques. Most medical students were not aware of and were not using evidence-based revision methods, and relied on conventional revision tools. They were, however, eager to learn about newer revision strategies.

Sagittal alignment of diverse mechanical complications following adult spinal deformity surgery.

To compare the sagittal alignment of patients with diverse mechanical complications (MCs) following adult spinal deformity (ASD) surgery with that of patients without MCs. A total of 371 patients who underwent ASD surgery were enrolled. The sagittal spinopelvic parameters were measured preoperatively and at the 6-month and last follow-up, and the global alignment and proportion (GAP) score was calculated. The subjects were divided into non-MC and MCs groups, and the MCs group was further divided into rod fracture (RF), screw breakage (SB), screw dislodgement (SD) and proximal junctional kyphosis (PJK) subgroups. Preoperatively, the RF group had greater thoracolumbar kyphosis (TLK) and relative upper lumbar lordosis (RULL); the SB group had the largest pelvic incidence (PI) and lumbar lordosis (LL); the SD group had the least global sagittal imbalance; and the PJK group had the highest thoracic kyphosis (TK), TLK and RULL. At the last follow-up, the RF and SB groups featured a large PI minus LL (PI-LL), while the PJK group featured a prominent TK; all the MCs subgroups had sagittal malalignment and a higher GAP score, and the SB group had the most severe cases. Logistic regressions showed that the relative spinopelvic alignment (RSA) score was correlated with RF, SB and SD, while the RSA and age scores were associated with PJK. Each patient with MCs had individual characteristics in the sagittal plane following ASD surgery, which may be helpful to understand the pathophysiology of poor sagittal alignment with its subsequent MCs and guide an eventual revision strategy.