Nevin Manimala

Eur J Pediatr. 2022 Sep 27. doi: 10.1007/s00431-022-04629-y. Online ahead of print.

ABSTRACT

Extremely preterm birth is associated with a high risk of chronic pulmonary insufficiency of prematurity (CPIP). Lung ultrasound score (LUS) proved capable to characterise CPIP progression beyond the acute setting, but still, post-discharge data remain lacking. We hypothesised a priori that LUS in both BPD and no-BPD infants declines with postnatal age from birth through early infancy. This observational retrospective cohort study included preterm infants < 32 gestational weeks, who underwent the follow-up for CPIP. LUS was assessed from birth to 8 months postnatal age, over antero-lateral (LUS) and posterior (pLUS) pulmonary areas, placing the transducer longitudinally over the midclavicular and midaxillary lines and medial to the scapular line respectively. Extended LUS (eLUS) including LUS and pLUS was calculated. The primary outcome was LUS time course. Secondary outcomes included the correlation between LUS and pLUS. Sixty-two infants were included: 22 (35.5%) in the BPD group and 40 (64.5%) in the no-BPD group. BPD group infants were smaller (weight 841 g (± 228) vs 1226 (± 328), p < 0.001) and younger (26.8 weeks (± 2.0) vs 28.9 (± 1.9), p < 0.001). LUS declined over time in the entire population (ß = – 1.75, p < 0.001) and in both no-BPD and BPD groups (ß = – 1.64, p < 0.001 and ß = – 1.93, p < 0.001, respectively). eLUS declined correspondingly (p < 0.001). LUS and likewise eLUS were significantly different between BPD and no-BPD groups over time (p < 0.001). Conclusion: LUS trajectory progressively decreased from birth to early infancy. BPD cohort tracked higher, implying a worse respiratory status. pLUS had a similar timepoint course, adding no further information to LUS. To the best of our knowledge, this is the first study that describes preterm LUS time course after discharge. LUS may help track the CPIP progression. What is Known: • Extremely preterm birth is associated with high risk of chronic pulmonary insufficiency of prematurity (CPIP). • Several studies investigated the ability of lung ultrasound score (LUS) to characterize CPIP progression beyond the acute setting, still post-discharge data remain lacking. What is New: • LUS trajectory progressively decreases from birth to early infancy; BPD cohort tracks higher, implying a worse respiratory status. pLUS has similar timepoint course, adding no further information to LUS. • The use of LUS may contribute to better characterising and monitoring CPIP in BPD and no-BPD infants.

PMID:36166097 | DOI:10.1007/s00431-022-04629-y

Clin Exp Med. 2022 Sep 27. doi: 10.1007/s10238-022-00890-5. Online ahead of print.

ABSTRACT

Bibliometric analysis is helpful to determine the most influential studies in a specific field. A large number of publications in anaphylaxis have been published. However, no bibliometric analysis of anaphylaxis was conducted based on our known. The aim of this study is to identify the top 100 most cited articles in anaphylaxis and analyze their bibliometric characteristics. We searched in the Web of Science core database on November 20, 2021. Articles were listed in descending order by their total citations. Hence the top 100 most cited articles in anaphylaxis were identified and analyzed. Bibliometric indicators included: year of publication, total number of citations and average citations per year (ACY), journal of publication and impact factor (IF), countries, institutes, and authors, which were analyzed by Biblioshiny. Co-occurrence was used to visualize the classification and hotspots. The top 100 most cited articles were published between 1991 and 2017. The largest number of articles was published in a single interval in 2006-2008. Total citations of the 100 articles were between 155 and 1241 and were positively correlated with the number of articles published in each 3-year interval. The top100 articles were published in 34 different journals. The Journal of Allergy and Clinical Immunology published the most (n = 41). The corresponding authors of the top100 articles were from 13 different countries, mostly in North America and Europe. Statistical analysis revealed a positive correlation between total number of citations and ACY (r = 0.670, p < 0.01) and between total number of citations and IF (r = 0.219, p < 0.05), whereas a negative correlation between ACY and length of time since publication (r = – 0.697, p < 0.01). The research focuses were classified into three clusters: (1) the epidemiology and management. (2) the risk factor and treatment. (3) the assessment and diagnosis. COVID-19 vaccines, drug allergy and management were the recent major topics. This bibliometric analysis reveals the progress and hotspots of research in anaphylaxis, which may lay a foundation for further research.

PMID:36166096 | DOI:10.1007/s10238-022-00890-5

Knee Surg Sports Traumatol Arthrosc. 2022 Sep 27. doi: 10.1007/s00167-022-07158-1. Online ahead of print.

ABSTRACT

PURPOSE: Computer-assisted surgery (CAS) total knee arthroplasty (TKA) remains a controversial area of surgical practice. The aim of this study is to report the ten-year revision rates and patient-reported outcome measures (PROMS) of a single-blinded, prospective, randomised controlled trial comparing electromagnetically (EM) navigated and conventional TKA.

METHODS: 199 patients were randomised to receive either EM navigated or conventional TKA where the aim of implantation was neutral mechanical alignment in all cases. Ten-year revision rates were collated and compared between the two intervention groups. Longitudinal PROMS data was collected prospectively at various time points up to 10 years post-operatively.

RESULTS: Over the ten-year period, there were 23 deaths (22.8%) in the EM navigation cohort and 30 deaths (30.6%) in the conventional cohort. At 10 years post-operatively, there was no statistically significant difference in all cause revision between the EM navigation and conventional cohort (4.0 vs 6.1%, p = 0.429). When analysing causes of revision that might be influenced by utilising EM navigation, there was no statistically significant difference in revisions (3.0% EM navigated vs 4.1% conventional group, p = 0.591). Patients that received navigated TKAs had improved Oxford Knee Society, American Knee Society Score and range of motion at 3 months following surgery compared to conventional TKA (p = 0.002, p = 0.032, and p = 0.05, respectively). However, from 1 to 10 years post-operatively, both interventions had equivalent outcomes.

CONCLUSION: There is no difference in revision rates or clinical outcomes comparing EM navigated versus conventional TKA at ten-year follow-up. The expected mortality rate makes it unlikely that a difference in revision rates will reach statistical significance in the future. In the setting of an experienced knee arthroplasty surgeon, it is difficult to justify the additional costs of CAS in TKA surgery.

LEVEL OF EVIDENCE: I.

PMID:36166095 | DOI:10.1007/s00167-022-07158-1

Eur J Orthop Surg Traumatol. 2022 Sep 27. doi: 10.1007/s00590-022-03369-x. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to compare the postoperative alignment of the lower limbs using fixed angle versus variable valgus angle distal femur resection in uncomplicated total knee replacement (TKR) and to determine the mean valgus correction angle (VCA) in the study population.

METHODS: This was a prospective comparative study conducted between July 2018 and December 2019 in patients with osteoarthritic knees who underwent primary TKR. Forty-nine patients with 54 knees completed the study. They were randomized into fixed valgus angle (group A) and variable valgus angle (group B) groups. Twenty-four patients with 26 knees were in group A who had distal femur resection with 5-degree valgus correction, while 25 patients with 28 knees were in group B who had distal femur resection with individualized valgus correction angle calculated from hip-knee-ankle scanogram.

RESULTS: The demographic data were comparable in the two groups. There was no statistically significant difference between the groups in the mean preoperative mechanical femorotibial angle (MFTA). The fixed angle group had a mean postoperative MFTA of 2.0 ± 2.8°, while variable angle group had a mean of 1.6 ± 2.4°. However, the difference between the groups did not reach statistical significance (p = 0.60). The mean VCA in the study population was 5.8 ± 1.2° (Range 4-9°).

CONCLUSION: Our study has shown that the use of variable valgus angle for distal femur resection in uncomplicated TKR did not significantly improve the accuracy of restoring the postoperative coronal alignment within 0 ± 3°.

PMID:36166094 | DOI:10.1007/s00590-022-03369-x

Eur Radiol. 2022 Sep 27. doi: 10.1007/s00330-022-09151-1. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the image quality and diagnostic performance of conventional motion-corrected periodically rotated overlapping parallel line with enhanced reconstruction (PROPELLER) MRI sequences with post-processed PROPELLER MRI sequences using deep learning-based (DL) reconstructions.

METHODS: In this prospective study of 30 patients, conventional (19 min 18 s) and accelerated MRI sequences (7 min 16 s) using the PROPELLER technique were acquired. Accelerated sequences were post-processed using DL. The image quality and diagnostic confidence were qualitatively assessed by 2 readers using a 5-point Likert scale. Analysis of the pathological findings of cartilage, rotator cuff tendons and muscles, glenoid labrum and subacromial bursa was performed. Inter-reader agreement was calculated using Cohen’s kappa statistic. Quantitative evaluation of image quality was measured using the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR).

RESULTS: Mean image quality and diagnostic confidence in evaluation of all shoulder structures were higher in DL sequences (p value = 0.01). Inter-reader agreement ranged between kappa values of 0.155 (assessment of the bursa) and 0.947 (assessment of the rotator cuff muscles). In 17 cases, thickening of the subacromial bursa of more than 2 mm was only visible in DL sequences. The pathologies of the other structures could be properly evaluated by conventional and DL sequences. Mean SNR (p value = 0.01) and CNR (p value = 0.02) were significantly higher for DL sequences.

CONCLUSIONS: The accelerated PROPELLER sequences with DL post-processing showed superior image quality and higher diagnostic confidence compared to the conventional PROPELLER sequences. Subacromial bursa can be thoroughly assessed in DL sequences, while the other structures of the shoulder joint can be assessed in conventional and DL sequences with a good agreement between sequences.

KEY POINTS: • MRI of the shoulder requires long scan times and can be hampered by motion artifacts. • Deep learning-based convolutional neural networks are used to reduce image noise and scan time while maintaining optimal image quality. The radial k-space acquisition technique (PROPELLER) can reduce the scan time and has potential to reduce motion artifacts. • DL sequences show a higher diagnostic confidence than conventional sequences and therefore are preferred for assessment of the subacromial bursa, while conventional and DL sequences show comparable performance in the evaluation of the shoulder joint.

PMID:36166084 | DOI:10.1007/s00330-022-09151-1

Unfallchirurgie (Heidelb). 2022 Sep 27. doi: 10.1007/s00113-022-01244-2. Online ahead of print.

ABSTRACT

Clinical trials must be planned and interpreted in the context of current best clinical and scientific evidence, undoubtedly provided by systematic reviews and meta-analyses, especially Cochrane Reviews. While many clinicians feel overwhelmed by this complex data source, few visualElements (e.g., the traffic light system of the Cochrane risk of bias [RoB‑2] tool, forest plots, etc.), together with indices such as the I² heterogeneity statistic, allow for a quick appraisal of all critical and necessary qualitative and quantitative information. The effectiveness of different treatment options can indirectly be assessed by methodological advancements like network meta-analyses.Point estimates of percentages are insufficient to describe the utility and value of a proposed novel intervention, which, in orthopedic and trauma surgery, often represents a step innovation. 95% confidence intervals and the so-called fragility index are helpful in determining the ultimate patient benefit.

PMID:36166082 | DOI:10.1007/s00113-022-01244-2

Eur J Trauma Emerg Surg. 2022 Sep 27. doi: 10.1007/s00068-022-02101-y. Online ahead of print.

ABSTRACT

PURPOSE: Most patients with a clinically suspected scaphoid fracture and normal initial radiograph are unnecessarily treated. Previously developed prediction rules using demographic and clinical risk are unable to accurately predict occult fractures. Adding other risk factors could enhance this. Therefore, we aim to explore if there are morphological risk factors of the wrist for sustaining a scaphoid fracture.

METHODS: We retrospectively included adult patients with a clinically suspected scaphoid fracture between 2013 and 2019 in our case-control study. There were 82 patients with a scaphoid fracture and 158 patients with a wrist contusion. Morphological risk factors were identified using statistical shape modelling (SSM) and linear measurements. Independent wrist shape variations on posteroanterior and lateral radiographs were captured in modes using SSM. Associations between outcomes and a scaphoid fracture were explored using logistic regression and the reliability was assessed.

RESULTS: Of the 15 posteroanterior modes and 8 lateral modes identified and linear measurements performed, 1 PA mode was associated with a scaphoid fracture (PA mode 4; OR 1.40, CI 1.04-1.93, p = 0.031). We described this mode as an ulna plus and narrower distal radius with more volar tilt and radial inclination. The reliability of the posteroanterior modes and linear measurements was mostly good/excellent and moderate/poor for the lateral modes.

CONCLUSION: There was one complex wrist shape significantly associated with a scaphoid fracture. Since the association was weak and the shape is difficult to identify radiographs, we believe this morphological risk factor would not enhance identifying occult scaphoid fractures in the future.

PMID:36166077 | DOI:10.1007/s00068-022-02101-y

Graefes Arch Clin Exp Ophthalmol. 2022 Sep 27. doi: 10.1007/s00417-022-05841-0. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to evaluate morphological features of corneal flap/cap and the correlations with corneal higher-order aberrations (HOAs) changes after femtosecond laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE).

METHODS: This was a retrospective study. Pre- and postoperative (1 and 3 months) corneal HOAs were assessed with Pentacam HR. The corneal flap/cap thickness at 32 points (± 1.5 mm, ± 2 mm, ± 2.5 mm, and ± 3 mm from the corneal vertex on meridian 0°/45°/90°/135°) were measured using anterior segment optical coherence tomography at 3 months postoperatively. Morphological features of corneal flap/cap including predictability (P), uniformity (U), and symmetry (S) were calculated and used for correlation analysis with corneal HOAs changes.

RESULTS: Eighty-six eyes (44 patients) and ninety-six eyes (50 patients) were involved in FS-LASIK and SMILE groups, respectively. Significant thicker corneal flap/cap than the predicted was observed at each measuring point and meridian in both groups (difference > 2.225 μm, the within-subject standard deviation over 6-mm optical zone). There was no statistically significant difference in predictability of corneal flap/cap thickness, while U_{6 mm} (P < .0001), U₀ (P < .001), U₄₅ (P = .002), U₉₀ (P < .0001), U₁₃₅ (P = .004), S_{6 mm} (P < .0001), S₀ (P < .001), and S₉₀ (P < .0001) over 6 mm zone were less in SMILE than in FS-LASIK. The changes of corneal tHOAs, Z (3, – 1), Z (3, 1), and SA were significantly correlated with morphological features of corneal flap/cap.

CONCLUSION: Both FS-LASIK and SMILE had good predictability in flap or cap thickness, while the uniformity and symmetry of SMILE cap were better than FS-LASIK flap. The quality of flap/cap was closely associated with the changes of corneal HOAs.

PMID:36166075 | DOI:10.1007/s00417-022-05841-0

Anaesthesiologie. 2022 Sep 27. doi: 10.1007/s00101-022-01204-w. Online ahead of print.

ABSTRACT

BACKGROUND: The poor availability of automatic external defibrillators (AED) and the modest knowledge of lay persons in handling these devices has led to an insufficient spread of public access defibrillation in Germany.

OBJECTIVE: This article examines whether the automated deployment of AED drones to out-of-hospital cardiac arrest can help to remedy this situation.

METHODS: Narrative literature review, evaluation of statistics, analysis of relevant media reports, and discussion of key research.

RESULTS: The present investigations are mainly located in the experimental field and demonstrate the feasibility and safety of drone use, as well as shorter times to first defibrillation, which is confirmed by initial clinical studies. Mathematical models also indicate cost-effectiveness of airborne AED delivery compared to ground dispatch. Integration into the chain of survival appears to be possible but adaptations to existing emergency medical service structures and close cooperation with regional first responder and AED schemes as well as local authorities is required to optimise patient benefit and efficiency.

CONCLUSION: The use of AED drones could probably contribute to improving public access defibrillation in Germany. This applies to both rural and urban regions. The technological requirements are met but flight regulations still have to be amended. In order to explore the full potential of this novel technology, further field trials are required to achieve smooth integration into existing emergency medical services.

PMID:36166065 | DOI:10.1007/s00101-022-01204-w

Anaesthesiologie. 2022 Sep 27. doi: 10.1007/s00101-022-01206-8. Online ahead of print.

ABSTRACT

BACKGROUND: Mortality and delirium in critically ill patients are affected by the provided analgesics and sedatives. The deeper the sedation and the higher the dose of analgesics applied, the more difficult it is to assess pain and the depth of sedation. Therefore, instrumental measurement methods, such as the measurement of the stimulus threshold of the nociceptive flexion reflex (NFRT), are becoming increasingly more important.

OBJECTIVE: The aim of the present study is to investigate a potential association between the level of the nociceptive flexion reflex, mortality, and the occurrence of delirium.

MATERIAL AND METHODS: By retrospectively analyzing a pilot data set of 57 ICU patients from the interdisciplinary surgical ICU of Ulm University Hospital surveyed between 11/2018 and 03/2020, a possible association between the NFRT, mortality, and the occurrence of delirium was calculated in an adjusted logistic regression model. Depending on the cut-off value, the stimulus threshold corridors result in the following comparison pairs: < 20 mA vs. 20-40 mA/20-50 mA/20-60 mA, > 40 mA vs. 20-40 mA, > 50 mA vs. 20-50 mA and > 60 mA vs. 20-60 mA. Results are presented as odds ratios (OR) adjusted for age, sex, height, TISS-28, SAPS II, RASS, BPS, and applied analgesics. Pain assessment was performed, in addition to the Behavioral Pain scale, ≥ 3 times daily by measuring NFRT.

RESULTS: A statistically nonsignificant tendency for an increase in mortality incidence occurred with an NFRT > 50 mA, versus a stimulus threshold corridor of 20-50 mA (OR 3.3, CI: 0.89-12.43, p = 0.07). A trend toward a reduction in delirium incidence occurred at an NFRT < 20 mA, versus a stimulus threshold corridor of 20-40 mA (OR 0.40, CI: 0.18-0.92, p = 0.03).

CONCLUSION: Based on the level of the NFRT, no recommendation can be made at this point to adjust the analgesic regimen of critically ill patients, who are unable to communicate. The observation of a tendency towards an increase in mortality at high stimulus thresholds or a reduction in the occurrence of delirium at low stimulus thresholds of the NFRT must be verified in standardized studies.

PMID:36166064 | DOI:10.1007/s00101-022-01206-8