Tag: pubmed

Arch Craniofac Surg. 2021 Apr;22(2):93-98. doi: 10.7181/acfs.2021.00122. Epub 2021 Apr 20.

ABSTRACT

BACKGROUND: Pediatric nasal fractures, unlike adult nasal fractures, are treated surgically as early as 7 days after the initial trauma. However, in some cases, a week or more elapses before surgery, and few studies have investigated the consequences of delayed surgery for pediatric nasal fractures. The purpose of this study was to evaluate the postoperative outcomes of pediatric nasal fractures according to the time interval between the initial trauma and surgery.

METHODS: The records of pediatric patients under 12 years old who underwent closed reduction of nasal bone fracture from March 2012 to February 2020 were reviewed. The interval between trauma and surgery was divided into within 7 days (early reduction) and more than 7 days (delayed reduction). Postoperative results were classified into five grades (excellent, good, moderate, poor, and very poor) based on the degree of reduction shown on computed tomography.

RESULTS: Ninety-eight patients were analyzed, of whom 51 underwent early reduction and 47 underwent delayed reduction. Forty-two (82.4%) of the 51 patients in the early reduction group showed excellent results, and nine (17.6%) showed good results. Thirty-nine (83.0%) of the 47 patients in the delayed reduction group showed excellent results and eight (17.0%) showed good results. No statistically significant difference in outcomes was found between the two groups (chi-square test p= 0.937). However, patients without septal injury were significantly more likely to have excellent postoperative outcomes (chi-square test p< 0.01).

CONCLUSION: No statistically significant difference was found in the outcomes of pediatric nasal fractures between the early and delayed reduction groups. Successful surgical results were found even in patients who received delayed reduction (more than 7 days after trauma).

PMID:33957734 | DOI:10.7181/acfs.2021.00122

Asian Spine J. 2021 May 10. doi: 10.31616/asj.2020.0268. Online ahead of print.

ABSTRACT

STUDY DESIGN: Prospective, randomized study of 100 patients with prolapsed intervertebral disc with an average of 12- to 18-month follow-up postoperatively.

PURPOSE: To compare the role of Gelfoam and autologous fat in the prevention of postoperative epidural fibrosis (EF) after lumbar spine surgery.

OVERVIEW OF LITERATURE: EF is a possible sequelae of lumbar disc surgery. Different treatments and surgical strategies have been attempted to prevent postoperative fibrosis without providing consistent long-term results.

METHODS: The study was conducted on 100 adult patients. The patients were randomly allocated into two groups of 50 patients each: group A, autologous fat group, and group B, Gelfoam group. The postoperative follow-up was conducted at intervals of 6 weeks, 3 months, 6 months, and 12 months. Both groups were evaluated clinically (Oswestry Low Back Pain Disability Questionnaire [ODI], Visual Analog Scale [VAS], Straight Leg Raising Test [SLRT]) and radiologically (using Ross grading by contrast magnetic resonance imaging [MRI]) for development of radicular pain and hence EF.

RESULTS: Based on the analysis, improvement in mean values of ODI score, VAS score, and SLRT were found to be statistically significant postoperatively at intervals of 6 weeks, 3 months, 6 months, and 12 months when compared individually in both groups. However, improvement was greater in the autologous fat group than in the Gelfoam group. Based on contrast-enhanced MRI, the number of patients who developed EF was smaller in the autologous fat group than in the Gelfoam group.

CONCLUSIONS: In the present study, on clinical and radiological assessment, we conclude that both groups prevent radicular pain and postoperative EF individually but relatively autologous fat was found to be more effective than Gelfoam in the prevention of EF and hence radicular pain.

PMID:33957745 | DOI:10.31616/asj.2020.0268

Asian Spine J. 2021 May 10. doi: 10.31616/asj.2020.0301. Online ahead of print.

ABSTRACT

STUDY DESIGN: This is a descriptive observational study.

PURPOSE: The objective of this study is to analyze and document the sagittal alignment of the spine and pelvis in normal Indian adult volunteers and compare these parameters with the study population of other races and ethnicities.

OVERVIEW OF LITERATURE: Given the importance of the spinopelvic parameters, there is a need to describe the parameters differentially in relation to the ethnicity of the studied individual. Very few reports have defined the normal physiological value. Ethnic differences are a significant factor not only when describing the anthropometric data but also when applying the findings to a different ethnic group. We have compared these values with other races and ethnicities so that we can know whether the principles of spinal fixation can be applied globally.

METHODS: In total, 100 participants were studied by using their anteroposterior and lateral radiographic images of whole of pelvic and spinal area. Additionally, various spinal and pelvic parameters were also measured. Subsequently, the outcomes were analyzed with respect to age, sex, and body mass index (BMI). The correlation between different parameters and differences in these parameters between Indians and other races/ethnicities along with population groups were also analyzed.

RESULTS: There was a significant increase in thoracic kyphosis (TK) from T1-T12 and T4-T12 with increasing age. Lumbar lordosis (LL), sacral translation (sagittal vertical axis), and pelvic tilt were significantly higher among females. Additionally, sacral slope (SS), pelvic incidence, C7 sagittal offset, and T9 sagittal offset were also higher in females. TK (T4-T12 and T1-T12), LL, SS, and pelvic incidence showed a significant correlation with BMI. As compared to European population, TK, segmental LL, and sacral translation were found to be significantly lesser in Indian population.

CONCLUSIONS: There is a statistically significant difference between Indians and other races/ethnicities and population groups with respect to TK, LL, and sacral translation. The values obtained can be considered as the physiological normal values for Indian population. Importantly, these values can serve as the reference values for future studies.

PMID:33957746 | DOI:10.31616/asj.2020.0301

Turk J Med Sci. 2021 May 7. doi: 10.3906/sag-2101-406. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: The aim of the study was to evaluate the effect of Controlling Nutritional Status (CONUT) score on the prognosis in patients with diffuse large B-cell lymphoma(DLBCL).

MATERIALS AND METHODS: The present study was a retrospective study. The CONUT score was calculated based on serum albumin, total cholesterol and lymphocyte levels. This study included a total of 266 patients, 131(49.2%) were female and 135(50.8%) were male. The median follow-up period was 51 months (range: 1?190).

RESULTS: The median age was 64 years. The cut off CONUT was 1.5. There was a significant difference between patients with high (?2) or low (<2) CONUT scores in terms of overall survival(OS) and progression-free survival(PFS). The 5-year OS and PFS in patients with high CONUT score was 52.1% and 49.7%. The 5-year OS and PFS in patients with low CONUT score was 79.8% and 75.6% (p<0.001). In the multivariate analysis for OS, age ?65 years (HR=1.80, p=0.028), Eastern Cooperative Oncology Group (ECOG) >1 (HR=2.04, p=0.006), stage IIIA?IVB disease (HR=2.75, p=0.001) and the CONUT score (HR=1.15, p = 0.003) were found statistically significant. In the multivariate analysis for PFS, age ?65 years (HR=2.02, p=0.007), stage IIIA?IVB disease (HR=2.42, p=0.002) and the CONUT score (HR=1.19, p=0.001) were found to be significant parameters.

CONCLUSION: High CONUT score reduces OS and PFS in DLBCL. CONUT score is an independent, strong prognostic index in patients with DLBCL.

PMID:33957727 | DOI:10.3906/sag-2101-406

Int Neurourol J. 2021 May 6. doi: 10.5213/inj.2040342.171. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to develop urodynamic criteria for more accurate diagnosis of bladder outlet obstruction (BOO) and detrusor underactivity (DU) in women with lower urinary tract symptoms (LUTS).

METHODS: Initially, in a group of 68 consecutive women with LUTS and increased post-void residual who had undergone urodynamic investigation we examined the level of agreement between operating physician’s diagnosis of BOO or DU and diagnosis according to urodynamic nomograms/indices, including the Blaivas-Groutz (B-G) nomogram, Urethral Resistance Association (URA), Bladder Outlet Obstruction Index (BOOI) and Bladder Contractility Index (BCI). Based on the initial results, we categorized 160 women into four groups using B-G nomogram and URA (Group 1: severe-moderate BOO, Group 2: mild BOO and URA≥20, Group 3: mild BOO and URA<20 and Group 4: non-obstructed) and compared urodynamic parameters. Finally, we redefined women as obstructed (group 1+2) and non-obstructed (group 3+4) for sub-analysis.

RESULTS: The agreement between B-G nomogram and physician’s diagnosis was poor in the mild obstruction zone (kappa=0.308, p=0.01). Adding URA (cutoff value 20), an excellent level of agreement was reached (kappa=0.856, p<0.001). Statistically significant differences were found between the four groups (ANOVA) in maximum flow (Qmax) (p<0.0001), voided volume (VV) (p=0.042), post void residual (PVR) (p=0.032), BOOI (p<0.0001) and BCI (p<0.0001) with a positive linear trend for Qmax and VV and negative linear trend for PVR and BOOI from group 1 to 4. In the subanalysis all parameters were statistically different between obstructed and nonobstructive women except BCI (Qmax: p=0.0001, VV: p=0.0091, PVR: p=0.0005, BOOI: p=0.0001).

CONCLUSIONS: The combination of B-G nomogram with the URA parameter increases the accuracy of diagnosing BOO among women with LUTS. Based on this combination, most women in the mild obstruction zone of the B-G nomogram would be considered underactive rather than obstructed.

PMID:33957716 | DOI:10.5213/inj.2040342.171

Turk J Med Sci. 2021 May 7. doi: 10.3906/sag-2004-110. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: Anterior cruciate ligament (ACL) injuries cause mechanoreceptor loss in the joint; therefore, proprioceptive deficits are observed after injury. In particular, proprioceptive measurements made in the functional position give more accurate results, and this is an area that requires further studies. This study aimed to evaluate proprioception in patients who had undergone ACL reconstruction (ACLR) in functional positions used in daily life (closed kinetic chain position), according to joint angles where ACL injuries occur more frequently, in comparison with healthy controls.

MATERIALS AND METHODS: Thirty-four participants who underwent ACLR using a hamstring tendon graft (aged 29.18 ± 8.16 years; body mass index (BMI), 26.58 ± 4.02 kg/cm2) and 31 healthy participants (aged 27.35 ± 5.74 years; BMI, 24.76 ± 2.98 kg/cm2) were included. Proprioception was assessed with an active angle repetition test, using an inclinometer in the closed kinetic chain position while standing. Participants were asked to perform single-leg squats until the angle at the knee joint was 30°. After the targeted angle was defined, the participants were asked to find the targeted angle. The difference between the targeted angle and the angle reached by the participants was calculated.

RESULTS: A statistically significant difference in the active joint position sense was found among the ACLR extremity, uninvolved extremity, and control extremity (p < 0.05). The proprioceptive sense between the two extremities in the ACLR group was similar, and the proprioceptive sense was worse than that of the control group.

CONCLUSION: To our knowledge, this is the first study to evaluate closed kinetic chain position in patients who underwent ACLR and showed that proprioceptive sense was still poor in patients with ACLR compared with the control group, even if an average of 24 months have elapsed since surgery.

PMID:33957722 | DOI:10.3906/sag-2004-110

Turk J Med Sci. 2021 May 7. doi: 10.3906/sag-2012-247. Online ahead of print.

ABSTRACT

OBJECTIVE: Hyperparathyroidism is an endocrine disorder characterized by hypercalcemia. Because of calcium?s effects on parathyroid glands, bone, intestine and kidney, it has an important place in homeostasis. The results of studies regarding hyperparathyroidism hemostasis are conflicting. Thromboelastography helps to evaluate all steps of hemostatic system. Our aim in this study was to investigate the possible role of hemostatic mechanisms in the development of thrombosis in hyperparathyroid patients with the modified rotation thromboelastogram (ROTEM).

METHODS: Twenty-two patients with primary hyperparathyroidism (PHPT) and 20 healthy controls were involved. This study was conducted in Eskisehir Osmangazi University Faculty of Medicine, Endocrinology and Hematology clinics for 2 years. The complete blood count, fibrinogen, D-dimer levels, prothrombin time, activated prothrombin time and ROTEM parameters [clot formation time (CFT), clotting time (CT), and maximum clot formation (MCF)] were determined by two activated tests, INTEM and EXTEM analyses. A thromboelastographic evaluation was performed in the preoperative and postoperative (three months after surgery) periods.

RESULTS: In INTEM assay, the CT (p= 0.012) and CFT (p= 0.07) values were increased in preoperative PHPT patients compared with the control group. Although there was a decrease in the postoperative CT and CFT values, no statistical difference was found.

CONCLUSION: The prolongation of the CT and CFT values were consistent with a hypocoagulable state in patients with PHPT. Hyperparathyroidism causes a hypocoagulable state that can be successfully assessed by ROTEM. Hemostatic changes, do not seem to have an effect on increased cardiovascular mortality.

PMID:33957726 | DOI:10.3906/sag-2012-247

Dtsch Med Wochenschr. 2021 May;146(10):677-682. doi: 10.1055/a-1380-1436. Epub 2021 May 6.

ABSTRACT

Specifying a singular specific cause of death or an appropriate causal chain in the death certificate can be challenging, especially in cases of elderly, multimorbid deceased persons.The German cause of death statistics suggest that mental illnesses, including dementia, are beneath the most frequent causes of death. But when looking at death certificates in the context of dementia considerable information gaps and a lack of plausibility in the causal chain can be observed quite regularly.In this article we give recommendations for the correct designation of the cause of death and underlying diseases in the death certificate. These recommendations are not only to be seen against an academic background. The correct registration of dementia in the causes of death statistics may be a basis for decision making in health politics and is hence in the interest of optimal patient care.

PMID:33957690 | DOI:10.1055/a-1380-1436

Obstet Gynecol. 2021 May 6. doi: 10.1097/AOG.0000000000004394. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the outcomes of the first pregnancy after fertility-sparing surgery in patients treated for early-stage ovarian cancer.

METHODS: We performed a retrospective study of women aged 18-45 years with a history of stage IA or IC ovarian cancer reported to the California Cancer Registry for the years 2000-2012. These data were linked to the 2000-2012 California Office of Statewide Health Planning and Development birth and discharge data sets to ascertain oncologic characteristics and obstetric outcomes. We included in the case group ovarian cancer patients who conceived at least 3 months after fertility-sparing surgery. The primary outcome was preterm birth, and only the first pregnancy after cancer diagnosis was considered. Secondary outcomes included small-for-gestational-age (SGA) neonates, neonatal morbidity (respiratory support within 72 hours after birth, hypoxic-ischemic encephalopathy, seizures, infection, meconium aspiration syndrome, birth trauma, and intracranial or subgaleal hemorrhage), and severe maternal morbidity as defined by the Centers for Disease Control and Prevention. Propensity scores were used to match women in a 1:2 ratio for the case group and the control group. Wald statistics and logistic regressions were used to evaluate outcomes.

RESULTS: A total of 153 patients who conceived after fertility-sparing surgery were matched to 306 women in a control group. Histologic types included epithelial (55%), germ-cell (37%), and sex-cord stromal (7%). Treatment for ovarian cancer was not associated with preterm birth before 37 weeks of gestation (13.7% vs 11.4%; odds ratio [OR] 1.23, 95% CI 0.69-2.20), SGA neonates (birth weight less than the 10th percentile: 11.8% vs 12.7%; OR 0.91, 95% CI 0.50-1.66), severe maternal morbidity (2.6% vs 1.3%; OR 2.03, 95% CI 0.50-8.25), or neonatal morbidity (both 5.9% OR 1.00, 95% CI 0.44-2.28).

CONCLUSION: Patients who conceived at least 3 months after surgery for early-stage ovarian cancer did not have an increased risk of adverse obstetric outcomes.

PMID:33957660 | DOI:10.1097/AOG.0000000000004394

Adv Nutr. 2021 May 6:nmab045. doi: 10.1093/advances/nmab045. Online ahead of print.

ABSTRACT

Appropriate planning, execution, and reporting of statistical methods and results is critical for research transparency, validity, and reproducibility. This paper provides an overview of best practices for developing a statistical analysis plan a priori, conducting statistical analyses, and reporting statistical methods and results for human nutrition randomized controlled trials (RCTs). Readers are referred to the other NURISH (NUtrition inteRventIon reSearcH) publications for detailed information about the preparation and conduct of human nutrition RCTs. Collectively, the NURISH series outlines best practices for conducting human nutrition research.

PMID:33957665 | DOI:10.1093/advances/nmab045