Category: Statistics

Med J Aust. 2021 Jun 29. doi: 10.5694/mja2.51157. Online ahead of print.

NO ABSTRACT

PMID:34187086 | DOI:10.5694/mja2.51157

J Knee Surg. 2021 Jun 29. doi: 10.1055/s-0041-1731327. Online ahead of print.

ABSTRACT

There is conflicting literature suggesting that intra-articular corticosteroid injections before total knee arthroplasty (TKA) may lead to an increase in the rate of postoperative complications, specifically periprosthetic joint infection (PJI). Thus, this retrospective review of all TKAs performed at a large, urban hospital will add valuable evidence to help guide future patient care. After exclusion criteria, we retrospectively reviewed 417 patients who received a TKA from a group of fellowship-trained orthopaedic surgeons between 2009 and 2016 at a single academic medical center. Minimum follow-up time was 1 year. Patients were separated into two groups: those who received a preoperative intra-articular corticosteroid injection and those who did not receive an injection. Subgroups were created based on the timing of their most recent preoperative injection: 0 to 3 months, 3 to 6 months, 6 to 12 months, 12+ months, and an unknown time period. Postoperative outcomes for PJI, revision TKA, and manipulation under anesthesia (MUA) were analyzed via a Chi-square test. No statistically significant postoperative differences were observed between groups: PJI (p = 0.904), revision TKA (p = 0.206), and MUA (p = 0.163). The temporal subgroups also failed to demonstrate a statistically significant result: PJI (p = 0.348), revision TKA (p = 0.701), and MUA (p = 0.512). This study revealed no absolute or temporal association between preoperative, intra-articular corticosteroid injections, and complications after TKA. Because these injections are a commonly used treatment modality prior to TKA, further studies should be conducted on a nationwide basis to draw more concrete conclusions.

PMID:34187066 | DOI:10.1055/s-0041-1731327

J Knee Surg. 2021 Jun 29. doi: 10.1055/s-0041-1731323. Online ahead of print.

ABSTRACT

The purpose of this study was to compare (1) operative time, (2) in-hospital pain scores, (3) opioid medication use, (4) length of stay (LOS), (5) discharge disposition at 90-day postoperative, (6) range of motion (ROM), (7) number of physical therapy (PT) visits, (8) emergency department (ED) visits, (9) readmissions, (10) reoperations, (11) complications, and (12) 1-year patient-reported outcome measures (PROMs) in propensity matched patient cohorts who underwent robotic arm-assisted (RA) versus manual total knee arthroplasty (TKA). Using a prospectively collected institutional database, patients who underwent RA- and manual TKA were the nearest neighbor propensity score matched 3:1 (255 manual TKA:85 RA-TKA), accounting for various preoperative characteristics. Data were compared using analysis of variance (ANOVA), Kruskal-Wallis, Pearson’s Chi-squared, and Fisher’s exact tests, when appropriate. Postoperative pain scores, opioid use, ED visits, readmissions, and 1-year PROMs were similar between the cohorts. Manual TKA patients achieved higher maximum flexion ROM (120.3 ± 9.9 versus 117.8 ± 10.2, p = 0.043) with no statistical differences in other ROM parameters. Manual TKA had shorter operative time (105 vs.113 minutes, p < 0.001), and fewer PT visits (median [interquartile range] = 10.0 [8.0-13.0] vs. 11.5 [9.5-15.5] visits, p = 0.014). RA-TKA had shorter LOS (0.48 ± 0.59 vs.1.2 ± 0.59 days, p < 0.001) and higher proportion of home discharges (p < 0.001). RA-TKA and manual TKA had similar postoperative complications and 1-year PROMs. Although RA-TKA patients had longer operative times, they had shorter LOS and higher propensity for home discharge. In an era of value-based care models and the steady shift to outpatient TKA, these trends need to be explored further. Long-term and randomized controlled studies may help determine potential added value of RA-TKA versus manual TKA. This study reflects level of evidence III.

PMID:34187067 | DOI:10.1055/s-0041-1731323

J Knee Surg. 2021 Jun 29. doi: 10.1055/s-0041-1731350. Online ahead of print.

ABSTRACT

Knee arthroscopy is one of the most common surgical procedures in orthopaedics and especially in sports medicine. Portal problems and effusion after knee arthroscopy have been reported. The fluid retention within the joint in knee arthroscopy can affect clinical outcomes, but there is no consensus on portal management. The studies of portal management in knee arthroscopy have mainly addressed wound healing and cosmetic problems. There is insufficient information in the literature about whether the irrigation fluid used in this effusion contributes to the process. This study investigates whether arthroscopic irrigation fluid is retained in the joint and whether portal-closure management has an effect on effusion. In this randomized, prospective study, 91 patients (46 [50.5%] sutured-portal group and 45 [49.5%] open-portal group) were included. Suprapatellar knee-diameter measurement and the number of times the dressing was changed were used to assess intra-articular fluid collection. The visual analog scale (VAS) score, Oxford knee score, and Knee Society score were used to evaluate knee problems. All portal wounds in both groups healed without any problems. Superficial or deep infection was not observed in either group. There was no statistically significant difference in VAS score, Oxford knee scores, and Knee Society scores between groups. Although there was a decrease in the knee diameter of both groups between the early postoperative period and first postoperative day, a statistically significant difference in knee diameter was found, especially in the open-portal group. There was a significant difference between the groups in terms of the number of dressings used in the first 24 hours after surgery. Leaving portals open may be effective in preventing intra-articular fluid retention. We thus advise leaving the arthroscopy portals open with just a simple dressing for selected patients.

PMID:34187068 | DOI:10.1055/s-0041-1731350

J Knee Surg. 2021 Jun 29. doi: 10.1055/s-0041-1731349. Online ahead of print.

ABSTRACT

Robotic-assisted technology has been developed to optimize the consistency and accuracy of bony cuts, implant placements, and knee alignments for total knee arthroplasty (TKA). With recently developed designs, there is a need for the reporting longer than initial patient outcomes. Therefore, the purpose of this study was to compare manual and robotic-assisted TKA at 2-year minimum for: (1) aseptic survivorship; (2) reduced Western Ontario and McMaster Universities Osteoarthritis Index (r-WOMAC) pain, physical function, and total scores; (3) surgical and medical complications; and (4) radiographic assessments for progressive radiolucencies. We compared 80 consecutive cementless robotic-assisted to 80 consecutive cementless manual TKAs. Patient preoperative r-WOMAC and demographics (e.g., age, sex, and body mass index) were not found to be statistically different. Surgical data and medical records were reviewed for aseptic survivorship, medical, and surgical complications. Patients were administered an r-WOMAC survey preoperatively and at 2-year postoperatively. Mean r-WOMAC pain, physical function, and total scores were tabulated and compared using Student’s t-tests. Radiographs were reviewed serially throughout patient’s postoperative follow-up. A p < 0.05 was considered significant. The aseptic failure rates were 1.25 and 5.0% for the robotic-assisted and manual cohorts, respectively. Patients in the robotic-assisted cohort had significantly improved 2-year postoperative r-WOMAC mean pain (1 ± 2 vs. 2 ± 3 points, p = 0.02), mean physical function (2 ± 3 vs. 4 ± 5 points, p = 0.009), and mean total scores (4 ± 5 vs, 6 ± 7 points, p = 0.009) compared with the manual TKA. Surgical and medical complications were similar in the two cohorts. Only one patient in the manual cohort had progressive radiolucencies on radiographic assessment. Robotic-assisted TKA patients demonstrated improved 2-year postoperative outcomes when compared with manual patients. Further studies could include multiple surgeons and centers to increase the generalizability of these results. The results of this study indicate that patients who undergo robotic-assisted TKA may have improved 2-year postoperative outcomes.

PMID:34187064 | DOI:10.1055/s-0041-1731349

Zootaxa. 2021 May 26;4975(3):544560. doi: 10.11646/zootaxa.4975.3.5.

ABSTRACT

Brachytrupes megacephalus (Lefebvre, 1827) is of significant biogeographic importance. It occurs in Sicily and on some of the circum-Sicilian and Pelagian islands, as well as in the Maltese Islands, Sardinia and the Maghreb (notably but not exclusively, in Algeria and Tunisia, where it maintains populations in both coastal and desert regions). Within European territory, it occurs solely in Italy and Malta, where it is protected under the EU Habitats Directive and the Bern Convention. In northern Africa, the species is regarded as a polyphagous pest, particularly in Saharan locations. The present work is based on field observations, mostly from the Maltese Islands, that span more than three decades; it provides insights on spatial distribution, population trends and behaviour. In examining the relationship between the species’ frequency during its mating season and weather conditions, results suggest a weak yet statistically significant correlation between mating strategies and ambient meteorological conditions. Moreover, patch occupancy in spring and autumn varied considerably within a specified area of study, primarily due to competitive mating strategies employed in spring, with an occupancy ratio of approximately 1:6. To-date, the species is known from 13 locations, one in Gozo and 12 in Malta, of which some constitute the Ahrax promontory metapopulation. Connectivity between the Ahrax subpopulation cluster is discussed in the light of habitat and topographical characteristics. Contrasting findings on variances in behaviour between Maltese populations and other populations in Sicily and the Maghreb are discussed. Discernible behavioural disparities include the length of excavated tunnels during spring and summer/autumn seasons in the different geographical locations, attraction to artificial sources of light, and the degree of damage to crops across geographic regions.

PMID:34187031 | DOI:10.11646/zootaxa.4975.3.5

Laryngorhinootologie. 2021 Jun 29. doi: 10.1055/a-1528-7584. Online ahead of print.

ABSTRACT

OBJECTIVE: Dysphagia constitutes a frequent post-operative functional impairment in head-and-neck cancer patients. This impairment can result in aspiration/penetration and limitations of oral intake. Therefore, often it requires a therapeutic intervention. In this study, prevalence of post-operative dysphagia and its associations with the tumour stage, localisation, patients’ age, and biological sex were analysed for the inpatient treatment setting.

MATERIAL AND METHODS: A total of 201 adult head-and-neck cancer patients (mean age 63 years) were analysed prospectively by FEES in two university hospitals in regard to their penetration/aspiration, limitations of oral intake, and need for therapeutic interventions directly after the operative tumour treatment. Additionally, the influence of the same patients’ characteristics on these three parameters were analysed by means of univariate and multivariate statistical methods.

RESULTS: Out of 201 patients, 66.7 % needed a therapeutic intervention because of their dysphagia, 57.2 % needed a nasogastral or PEG tube due to limitations of oral intake, 45.3 % had an aspiration. In the latter subgroup, 38.5 % had a silent aspiration. Higher tumour stage, patients’ higher age and male sex were shown to be significant influence factors for dysphagia, tumour localisation showed only a marginally significant result.

CONCLUSIONS: The study demonstrated a clinical importance and relevance of the consequent and systematic treatment of post-operative dysphagia in head-and-neck cancer patients in the acute care units as a constituent of a modern oncological therapy.

PMID:34187052 | DOI:10.1055/a-1528-7584

J Knee Surg. 2021 Jun 29. doi: 10.1055/s-0041-1731352. Online ahead of print.

ABSTRACT

In the absence of effective long-term repair of meniscal injuries, damage to the knee may lead to the development of osteoarthritis. Recent reports have recommended meniscal repair to be undertaken in all cases of meniscal tears. However, the most common complication encountered during repair of the medial meniscus is iatrogenic cartilage and meniscal injury due to its unclear visualization. The aim of this study is to evaluate the long-term clinical and radiological results of the pie-crust (PC) technique performed during the repair of medial meniscal tears. This retrospective study included 86 patients who underwent arthroscopic medial meniscus repair. PC technique was performed if the medial joint width was less than 5 mm. The patient population was divided into two groups as who underwent meniscus repair with PC technique (PC + repair group) or not (repair group). All patients were evaluated clinically (Kujala score, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity score) and radiologically (medial joint width and valgus laxity angle). When the medial joint width measurements before the PC technique and at the postoperative first and sixth months were compared, it was found to be statistically significant (p < 0.05). However, there was no significant difference between the preoperative and 12-month postoperative joint width measurements (p > 0.05). At the 12-month follow-up, no statistically significant difference was determined for the valgus laxity angle in the PC group compared with preoperative values (p > 0.05). The follow-up Kujala score, IKDC subjective score, Lysholm score, and Tegner activity score were similar between the groups. The clinical scores in both groups were determined to have statistically significant increase at 12-month postoperatively compared with the preoperative values (p < 0.05). The results of this study showed that performing the PC technique prior to medial meniscal tear repair increase the medial joint visualization safely and effectively without permanent valgus laxity.

PMID:34187063 | DOI:10.1055/s-0041-1731352

Zootaxa. 2021 May 21;4974(3):585595. doi: 10.11646/zootaxa.4974.3.7.

ABSTRACT

The freshwater leech family Salifidae Johansson has a Paleotropical range, with a hotspot of species richness in the Oriental Region, and a few species endemic to Africa, Madagascar, and Reunion. Barbronia gwalagwalensis Westergren Siddall, 2004 was thought to be a characteristic example of the latter group being a lineage endemic to South Africa. However, we found that this species also occurs in Asia (Myanmar and Korea). Our time-calibrated phylogeny based on the mitochondrial cytochrome c oxidase subunit I (COI) gene reveals that the split between the African and Asian populations of this species occurred in the mid-Pleistocene, approximately 1.3 Ma ago (95% HPD 0.7-2.1 Ma). The statistical biogeographic modeling indicates that a B. gwalagwalensis population in South Africa most likely originated due a long-distance dispersal event with a subsequent vicariance (probability = 88.9%). A Late Quaternary range extension towards South Africa is known to occur in some other freshwater taxa (e.g. the freshwater mussel Unio caffer Krauss species group), which agrees with our hypothesis on the ancient origin of the South African B. gwalagwalensis population. Conversely, we can assume that the African population of this species was recently introduced from Asia. If so, the high levels of genetic divergence between African and Asian populations could be a part of a more general phylogeographic pattern historically originated within the Asian subcontinent due to the isolation by orographic or marine barriers. These two alternative hypotheses need further research efforts, i.e. sampling and sequencing of other Barbronia taxa, the ranges of which are situated between South Africa and Southeast Asia, as well as of topotypes of B. weberi (Blanchard, 1897) from Indonesia. Finally, our results highlight that the salifid genus Barbronia Johansson originated in the Oriental Region and that these leeches share both recently and historically high potential for long-distance dispersal events.

PMID:34186580 | DOI:10.11646/zootaxa.4974.3.7

Zootaxa. 2021 Jun 18;4990(1):1-22. doi: 10.11646/zootaxa.4990.1.1.

ABSTRACT

All the Turkish populations studied, both those previously assigned to D. dryada (Subaşı and Yoldere villages, near Hopa) and those attributed to D. clarkorum (the largest sample studied so far, 177 specimens in total), are indistinguishable from each other and therefore must all be ascribed to the natural variability of a monotypic D. clarkorum. The Georgian specimens from the Type Locality of D. dryada (Charnaly river gorge, Chevachauri district) are clearly different, so that taxon cannot be considered a simple synonym for D. clarkorum, but as a valid taxon, although its proper status (more probably as a subspecies of D. clarkorum), is yet to be clarified. It is a highly threatened population, so studies should be done in vivo or with as low intrusiveness as possible. Darevskia dryada is clearly larger (SVL) than any D. clarkorum studied, with strongly longer heads and pilei in adult males (and hence more teeth in dentary bone), and higher dorsalia counts. There also seem to be (but need to be studied in a larger sample) more longitudinal rows of temporal scales between tympanic and parietal plates, a tendency to have more supralabial scales; comparatively smaller values for longitudinal rows of scales on the ventral surface of the thigh between the femoral pores and the outer row of enlarged scales, and higher collaria, and circumanalia scales. Other differences in femoralia and gularia are also reflected in Darevsky Tuniyev’s (1997) tables and should also be investigated with more Georgian specimens. Two supposed discriminant characters, the frontonasal index and the presence of developed masseteric, are not valid. The frontonasal index does not discriminate both taxa; D dryada specimens fall inside the variation of D. clarkorum for this character. Also the presence of a developed masseteric plate is supposed to be rare if at all in D. clarkorum but always present in D. dryada; however, it appears in nearly 75% of D. clarkorum studied and in all D. dyada, so is also no longer valid for taxa discrimination. Although very similar, D. clarkorum and D. dryada are morphologically different, and genetic studies (as the unpublished results mentioned by Fu, 1999) do not make the provenance of the specimens clear, and hence the correct identification of the supposed specimens of D. dryada used. There are no geographical clines in D. clarkorum. However, as stated by Schmidtler et al. (2002), there is an inverse relationship between altitude and dorsalia values in D. clarkorum. Both the general differentiation between populations and the scalation (dorsalia) appear statistically correlated with the altitude and also with latitude (being both factors not strictly the same). The correlation seems to be stronger with morphology in general (multiple scalation characters and head biometry) than only with dorsalia. In the case of the general differentiation among samples, it is also significantly correlated with temperatures during the activity period (April-September) and with precipitation during incubation (July-August). As these climatic parameters of temperature and precipitation are not directly correlated with the dorsalia variation, the relation with altitude (and perhaps latitude) must be linked to some other climatic parameter not studied here, perhaps solar radiation or evapotranspiration.

PMID:34186776 | DOI:10.11646/zootaxa.4990.1.1