The Relative Merits of Posterior Surgical Treatments for Multi-Level Degenerative Cervical Myelopathy Remain Uncertain: Findings from a Systematic Review.

OBJECTIVES: To assess the reporting of study design and characteristics in multi-level degenerative cervical myelopathy (DCM) treated by posterior surgical approaches, and perform a comparison of clinical and radiographic outcomes between different approaches. METHODS: A literature search was performed in Embase and MEDLINE between 1995-2019 using a sensitive search string combination. Studies were selected by predefined selection criteria: Full text articles in English, with >10 patients (prospective) or >50 patients (retrospective), reporting outcomes of multi-level DCM treated by posterior surgical approach. RESULTS: A total of 75 studies involving 19,510 patients, conducted worldwide, were identified. Laminoplasty was described in 56 studies (75%), followed by laminectomy with (36%) and without fusion (16%). The majority of studies were conducted in Asia (84%), in the period of 2016-2019 (51%), of which laminoplasty was studied predominantly. Twelve (16%) prospective studies and 63 (84%) retrospective studies were identified. The vast majority of studies were conducted in a single centre (95%) with clear inclusion/exclusion criteria and explicit cause of DCM. Eleven studies (15%) included patients with ossification of the posterior longitudinal ligament exclusively with cohorts of 57 to 252. The clinical and radiographic outcomes were reported with heterogeneity when comparing laminoplasty, laminectomy with and without fusion. CONCLUSIONS: Heterogeneity in the reporting of study and sample characteristics exists, as well as in clinical and radiographic outcomes, with a paucity of studies with a higher level of evidence. Future studies are needed to elucidate the clinical effectiveness of posterior surgical treatments

Echocardiographic findings and joint hypermobility: patients with mitral valve prolapse vs. healthy controls

"nBackground: Mitral valve prolapse is a relatively common valvular abnormality in most communities and joint hypermobility (JHM) is also seen in many healthy people as well as in certain clinical disorders, such as Marfan syndrome. The present study was designed to investigate the association between joint hypermobility and mitral valve prolapse (MVP) in an Iranian population sample. "nMethods: Fifty-seven patients with nonrheumatic and isolated mitral anterior leaflet prolapse (24 men and 33 women, mean age 23.5 +/-2.3) and 51 healthy subjects (20 men and 31 women, mean age 22.9+/-2.3) were studied. The presence of JHM was evaluated according to the Carter-Wilkinson & Beighton criteria. Echocardiographic examination was performed in all subjects and the correlation between the echocardiographic features of the mitral valve and the hypermobility score were investigated. "nResults: The frequency of JHM in patients with MVP was found to be significantly higher than that of controls (26.3% vs. 7.8%), with mean JHM scores of 3.1+/-2.2 and 1.9+/-1.7, respectively. The patients in the MVP group had significantly increased the anterior mitral leaflet thickness (AMLT, 3.4+/-0.4 mm vs. 3.0+/-0.3 mm; p<0.0005) and maximal leaflet displacement (MLD, 2.4+/-0.3 mm vs. 1.5+/-0.2 mm; p<0.0005) compared to the controls. "nConclusions: We detect a statistically significant relationship between isolated MVP and joint hypermobility as well as between the severity of JHM and echocardiographic features of the mitral leaflets. These results suggest a common etiology for MVP and JHM, which should be investigated in future well-conducted studies

Maximising opportunities at medical school to support a career in surgery

Introduction: During medical school, students have numerous opportunities to develop their portfolios for a career in surgery, such as undertaking additional surgical placements and participating in surgical research. However, at present, there is little guidance available for medical students on how to build a strong portfolio for the UK core surgical training application. This article outlines work undertaken to provide concise guidance to support future surgeons, via application of the competency-based CanMEDS framework to the current UK core surgical training specification. Materials and Methods: A pre-conference meeting was arranged for medical students at the Society of Academic and Research Surgeons annual conference in January 2018. Self-selected research enthusiasts from different university years discussed practical approaches to pair the CanMEDS model with the core surgical training specification, with support from the STARSurg Collaborative committee to facilitate discussion. A nominal group-based method was adopted in order to reach areas of consensus. Results: Practical tips and recommendations for each respective CanMEDS domain (communicator, collaborator, leader, health advocate, scholar, professional) were made in relation to the core surgical training specification. These included key action points and named opportunities that are currently available to UK medical students. Conclusions: A consensus approach was taken to address key areas of competence across each CanMEDS domain. This informed the development of a guidance framework to support students to develop a strong portfolio for a core surgical training application. This framework can be followed by medical students, equipping them with the skills necessary to succeed in their future surgical career

The efficiency of mechanical orthoses in affecting parameters associated with daily living in spinal cord injury patients: a literature review

Objective: The most simple and common approach in providing standing and walking by subjects with spinal cord injury (SCI) is the use of mechanical orthoses. These include traditional orthoses, medial linkage orthoses (MLOs) and reciprocating gait orthoses (RGOs). Independence, energy expenditure, gait parameters, system reliability and cosmesis are important factors in orthotic design. The aim of this review was to compare the evidence of existing mechanical orthoses to that of other types regarding these factors. Methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) method was used by an experience researcher based on selected keywords and their composition and an electronic search was performed in well-known databases. Results: Twenty articles were selected for final evaluation. Many were case studies, and also had limited and heterogeneous sample sizes with different instruments used for evaluation. The results of the analysis demonstrated that independence and cosmesis are improved when using MLOs, but gait parameters, energy expenditure and stability are all improved when using RGOs. Conclusion: Those mechanical orthoses which have reciprocal motion and congruency between the anatomical and orthotic joints have been shown to provide positive effects on patient lifestyles. However, further improvement is needed to more effectively meet the needs of SCI patients. •Implications for Rehabilitation •The most simple and traditional approach to enable standing and walking by people with SCI is use of purely mechanical orthoses. •The most important factors that increase rejection rates of orthoses in paraplegia patients are excessive energy expenditure and increased applied force on upper limb joints. •Improvement of the structure of mechanical orthoses is needed to improve independence, energy expenditure, and gait parameters, and is an important approach to improve ambulatory function in subjects with paraplegia