Long-term Outcomes of Operatively and Non-operatively Treated Spina Bifida Scoliosis

Background The purpose of this study was to evaluate outcomes in Spina Bifida Cystica adults, treated non-operatively or operatively for scoliosis during childhood. Methods Patients with SBC scoliosis (minimum Cobb angle >50 degrees) treated at the Hospital for Sick Children or the Children’s Hospital of Eastern Ontario (1991-2007 inclusive) were recruited. In addition to clinical and radiological assessments, health related quality of life (HRQOL) outcomes included the: a) Spina Bifida Spine Questionnaire (SBSQ) and b) Medical Outcomes Study-36 Item Short Form Health Survey (SF-36). Results The operative and non-operative patients were statistically similar at baseline on the following variables: a) age, b) sex, c) living situation, d) ambulation, and e) neurological motor level. At an average follow-up of 14.1+/-4.3 years, groups were statistically similar with respect to: a) SF-36 and b) SBSQ scores. Conclusion Spinal fusion in SBC scoliosis corrected coronal deformity and stopped progression, but had no overall effect on HRQOL.MAS

GMDH-type neural network approach for modeling the discharge coefficient of rectangular sharp-crested side weirs

Estimating the discharge coefficient using hydraulic and geometrical specifications is one of the influential factors in predicting the discharge passing over a side weir. Taking into account the fact that existing equations are incapable of estimating the discharge coefficient well, artificial intelligence methods are used to predict it. In this study, Group Method of Data Handling (GMDH) was used for the purpose of predicting the discharge coefficient in a side weir. The Froude number (F1), weir dimensionless length (b/B), ratios of weir length to depth of upstream flow (b/y1) and weir height to its length (p/y1) were taken as input parameters to express a new model for predicting the discharge coefficient. Two different sets of laboratory data were used to train the artificial network and test the new model. Different statistical indexes were used to evaluate the performance of the GMDH model presented for two states, training and testing. The results indicate that the proposed model predicts the discharge coefficient precisely (MAPE = 5.263 & RMSE = 0.038) and this model is more accurate in predicting than the feed-forward neural network model and existing nonlinear regression equations

Mortality rate of geriatric acetabular fractures is high compared with hip fractures. A matched cohort study

© 2020 Lippincott Williams and Wilkins. All rights reserved. Objectives:Compare acute complication and mortality rates of geriatric patients with acetabular fractures (AFs) matched to hip fractures (HFs).Design:Retrospective cohort study.Setting:American College of Surgeons National Surgical Quality Improvement Project.Patients:Using Current Procedural Terminology codes, the American College of Surgeons National Surgical Quality Improvement Project registry was used to identify all patients ≥60 years from 2011 to 2016 treated for AFs undergoing open reduction internal fixation (ORIF) and HFs (undergoing ORIF, hemiarthroplasty, or cephalomedullary nail).Outcome Measurements:Patient characteristics, comorbidities, functional status, acute complications, and mortality rates were recorded. Patients were matched 1:5 (AF:HF). Chi-square, Fisher exact, and Mann-Whitney U tests were used to compare groups, and multivariable logistic regression was used to compare the risk of complications or death while adjusting for relevant covariates.Results:A total of 303 AF patients (age: 78.2 ± 9.2 years/59.7% females/27.1% wall, 28.4% one column and 45.2% 2 columns ORIF) were matched to 1511 HF patients (age: 78.3 ± 9.1 years/60.2% females/37.2% hemiarthroplasty, 16.3% ORIF and 47.4% cephalomedullary nail). Length of stay (8.4 ± 7.1 vs. 6.4 ± 5.9 days) and time to surgery [(TS) 2.3 ± 1.8 versus 1.2 ± 1.4 days] were longer in the AF group (P \u3c 0.01). Unadjusted mortality rates were nonsignificantly higher for AFs versus HFs (6.6% vs. 4.6%, P = 0.14). After covariable adjustment, the risk of mortality was significantly higher for AFs versus HFs (odds ratio: 1.89, 95% confidence interval: 1.07-3.35).Conclusion:Geriatric AFs pose a significantly higher adjusted mortality risk when compared with HF patients. Strategies to mitigate risk factors in this population are warranted.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence

The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery: a matched cohort analysis

Aims: This study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common orthopaedic procedures. Methods: Using the National Surgical Quality Improvement Programme (NSQIP) database, patients who underwent common orthopaedic surgery procedures from 1 January to 31 December 2021 were extracted. Patient preoperative COVID-19 status, demographics, comorbidities, type of surgery, and postoperative complications were analyzed. Propensity score matching was conducted between COVID-19-positive and -negative patients. Multivariable regression was then performed to identify both patient and provider risk factors independently associated with the occurrence of 30-day postoperative adverse events. Results: Of 194,121 included patients, 740 (0.38%) were identified to be COVID-19-positive. Comparison of comorbidities demonstrated that COVID-19-positive patients had higher rates of diabetes, heart failure, and pulmonary disease. After propensity matching and controlling for all preoperative variables, multivariable analysis found that COVID-19-positive patients were at increased risk of several postoperative complications, including: any adverse event, major adverse event, minor adverse event, death, venous thromboembolism, and pneumonia. COVID-19-positive patients undergoing hip/knee arthroplasty and trauma surgery were at increased risk of 30-day adverse events. Conclusion: COVID-19-positive patients undergoing orthopaedic surgery had increased odds of many 30-day postoperative complications, with hip/knee arthroplasty and trauma surgery being the most high-risk procedures. These data reinforce prior literature demonstrating increased risk of venous thromboembolic events in the acute postoperative period. Clinicians caring for patients undergoing orthopaedic procedures should be mindful of these increased risks, and attempt to improve patient care during the ongoing global pandemic. Cite this article: Bone Jt Open 2023;4(9):704–712

The Ideal Total Hip Replacement Bearing Surface in the Young Patient: A Prospective Randomized Trial Comparing Alumina Ceramic-On-Ceramic With Ceramic-On-Conventional Polyethylene: 15-Year Follow-Up

© 2017 Background: The optimum bearing surface for total hip arthroplasty remains debatable. We have previously published our outcome at 10 years and this represents the 15-year follow-up. Methods: A total of 58 hips (in 57 patients with a mean age of 42 years) were randomized to receive either ceramic-on-ceramic (CoC) or ceramic-on-polyethylene (CoP) total hip arthroplasty. We prospectively followed for survivorship, functional outcomes (using the Harris Hip Score and the St Michael\u27s Hip Score [SMH]), and radiological outcomes. Results: At a minimum of 15 years, 3 patients had died, but not been revised. Seven were lost to follow-up. Five cases from the CoP group were revised (4 for polyethylene wear and osteolysis). Four from the CoC were revised; one each for head fracture, instability, infection, and trunnionosis. Both groups showed statistically significant improvements in Harris Hip Score scores and SMH functional scores, with no difference between the 2 bearings. For the CoP group, there was an improvement from 15.6 to 21.5 in the SMH and from 48.8 to 88.7 (P \u3e.05); and for CoC, this improvement was 15.8 to 23.5 and 50.3 to 94.6 (P \u3e.05), respectively. Mean wear rate of the polyethylene was 0.092 mm/y and for the CoC was 0.018 mm/y. Two patients in the CoC group had evidence of acetabular osteolysis vs 3 in the CoP. Six patients had femoral osteolysis in the CoC group and 12 in the CoP group. Conclusion: Survivorship and function of the 2 bearing groups remains comparable; while the polyethylene wear and osteolysis may represent issues in the future

First report on self-rated health in a nationally-representative sample of Iranian adolescents: the Caspian-iii study

Objective: To evaluate predictive factors of adolescents′ appraisal of their health. Methods: The nationwide study, entitled "Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Diseases (CASPIAN) study," was conducted in 2010 among Iranian school students, aged 10-18. In addition to demographic factors and physical examination, variables as family structure, nutrition habits, physical activity, smoking, hygienic habits, violence, school attachment, family smoking, and family history of chronic diseases were assessed. The dependent variable is the self-rated health (SRH) and it was measured by 12 items, which had already been combined through latent class analysis. We had taken a dichotomous variable, i.e. the higher values indicate better SRH. The dependent variable was regressed on all predictors by generalized additive models. Results: 75% of adolescents had a good SRH. The linear and smooth effects of independent variables on SRH were observed. Among all the variables, physical activity had a positive linear effect on SRH (β = 0.08, P value = 0.003). Smoking, violence, and family history of disease associated to SRH non-linearly (P value < 0.05). Family smoking (β = -0.01) and hygienic habits (β = 0.27) related to SRH both linearly and non-linearly. Conclusions: Physical health and high risk behavior, either of linear or non-linear effect, are factors, which seem to shape the adolescents′ perception of health