Search

Objective: To compare functional outcome of microscopic and endoscopic approach regarding type of ossiculoplasty. Methods: In this retrospective study, cases who had undergone type-II and type-III tympanoplasty between February 2007 to September 2019 were divided into two groups according to the type of approach as microscopic and endoscopic. In cases with type-II reconstruction; Partial Ossicular chain Replacement Prosthesis (PORP), incus interposition and bone cement were used in order of frequency. Whereas in cases with type-III reconstruction, only Total Ossicular chain Replacement Prosthesis (TORP) was used. The average Air Bone Gap (ABG) was determined pre- and post-operatively for the calculation of Air Conductance Gain (ACG). The ACG, pre- and post-operative ABG values of each group were compared with regard to the type of ossiculoplasty. Results: A total of 79 cases consisting of 32 females and 47 males who had undergone type-II and type-III tympanoplasty were enrolled. No statistically significant difference between microscopic and endoscopic approach was found in terms of ACG (p = 0.42), pre-(p = 0.23) and postoperative ABG (p = 0.99). We did not find any significant difference in terms of ACG, pre- and postoperative ABG between two approaches for type-II and type-III reconstructions (p>0.05). Conclusions: According to the current study, endoscopic approach in type-II and type-III reconstruction is at least reliable as microscopic approach regarding functional outcome. Since both techniques have similar functional results, other factors (anatomic characteristics, habitude of the surgeon and duration of the surgery) should be considered when choosing the technique. Level of evidence: In the current paper we present a retrospective comparative study of two different approaches of a particular type of otologic surgery. Level of evidence corresponds to level III.

Children with traumatic brain injury are at risk of neurocognitive and behavioural impairment. Although there is evidence for abnormal brain activity in resting-state networks after TBI, the role of resting-state network organisation in paediatric TBI outcome remains poorly understood. This study is the first to investigate the impact of paediatric TBI on resting-state network organisation using graph theory, and its relevance for functional outcome. Participants were 8–14 years and included children with (i) mild TBI and risk factors for complicated TBI (mildRF+, n = 20), (ii) moderate/severe TBI (n = 15), and (iii) trauma control injuries (n = 27). Children underwent resting-state functional magnetic resonance imaging (fMRI), neurocognitive testing, and behavioural assessment at 2.8 years post-injury. Graph theory was applied to fMRI timeseries to evaluate the impact of TBI on global and local organisation of the resting-state network, and relevance for neurocognitive and behavioural functioning. Children with TBI showed atypical global network organisation as compared to the trauma control group, reflected by lower modularity (mildRF + TBI and moderate/severe TBI), higher smallworldness (mildRF + TBI) and lower assortativity (moderate/severe TBI ps < .04, Cohen's ds: > .6). Regarding local network organisation, the relative importance of hub regions in the network did not differ between groups. Regression analyses showed relationships between global as well as local network parameters with neurocognitive functioning (i.e., working memory, memory encoding; R2 = 23.3 - 38.5%) and behavioural functioning (i.e., externalising problems, R2 = 36.1%). Findings indicate the impact of TBI on global functional network organisation, and the relevance of both global and local network organisation for long-term neurocognitive and behavioural outcome after paediatric TBI. The results suggest potential prognostic value of resting-state network organisation for outcome after paediatric TBI.

Background: In the treatment of anterior cruciate ligaments injuries in both young athletes and the general population, arthroscopic reconstruction has emerged asthe gold standard. Anterior cruciate ligament injuries have been steadily rising as the frequency of road traffic accidents and the number of young athletes participating in sports activities rise. The primary goal of surgery and the rehabilitation process is to rebuild the damaged ligament with an appropriate graft that provides a good functional outcome in the post-operative knee. Analysis of the literature revealed multiple graft options, including the semitendinosus tendon, quadriceps tendon, patellar bone graft, peroneus longus tendon, and other allografts, in their order of use. Recently peroneus longus tendon and semitendinosus tendon are being used in our college for the reconstruction of the injured ACL ligament. The goals of the treatmentare to restore the function of injured knee and to help the patient return to his physicalactivities as early as possible.

It remains unknown whether the global small vessel disease (SVD) burden predicts post-stroke outcomes.In a prospective multicenter study of 666 ischemic and hemorrhagic stroke patients, we quantified magnetic resonance imaging (MRI)-based SVD markers (lacunes, white matter hyperintensities, microbleeds, perivascular spaces) and explored associations with 6- and 12-month cognitive (battery of 15 neuropsychological tests) and functional (modified Rankin scale) outcomes.A global SVD score (range 0-4) was associated with cognitive impairment; worse performance in executive function, attention, language, and visuospatial ability; and worse functional outcome across a 12-month follow-up. Although the global SVD score did not improve prediction, individual SVD markers, assessed across their severity range, improved the calibration, discrimination, and reclassification of predictive models including demographic, clinical, and other imaging factors.SVD presence and severity are associated with worse cognitive and functional outcomes 12 months after stroke. Assessing SVD severity may aid prognostication for stroke patients.In a multi-center cohort, we explored associations of small vessel disease (SVD) burden with stroke outcomes. SVD burden associates with post-stroke cognitive and functional outcomes. A currently used score of SVD burden does not improve the prediction of poor outcomes. Assessing the severity of SVD lesions adds predictive value beyond known predictors. To add predictive value in assessing SVD in stroke patients, SVD burden scores should integrate lesion severity.

The eyebrow is a complex structure of the human face, which has both functional (communication) and aesthetic aspects and contributes to a persons’ individual appearance. Ptosis of the eyebrow is a common condition, especially among the elderly and smokers. Facial appearance is disrupted by eyebrow ptosis, and in many cases, correction and treatment are needed. No specific type of browlift has been shown to be superior to another, and since there is a wide variation in treatment preference between patients, it requires an individual approach to each specific patient. This review provides an overview of the history of the browlift, non-surgical treatment and current surgical techniques available.Level of evidence: Not ratable.

Patients with the 22q11.2 deletion syndrome (DS) show an increased risk of developing a psychotic illness lifetime. 22q11.2DS may represent a reliable model for studying the neurobiological underpinnings of schizophrenia. The study of social inference abilities in a genetic condition at high risk for psychosis, like 22q11.2DS, may shed light on the relationships between neurocognitive processes and patients' daily general functioning. The study sample consisted of 1736 participants, divided into four groups: 22q11.2DS patients with diagnosis of psychotic disorder (DEL SCZ, N = 20); 22q11.2DS subjects with no diagnosis of psychosis (DEL, N = 43); patients diagnosed with schizophrenia without 22q11.2DS (SCZ, N = 893); and healthy controls (HC, N = 780). Social cognition was assessed through The Awareness of Social Inference Test (TASIT) and general functioning through the Specific Levels of Functioning (SLoF) scale. We analysed data through regression analysis. The SCZ and DEL groups had similar levels of global functioning; they both had significantly lower SLoF Total scores than HC (p < .001); the DEL SCZ group showed significantly lower scores compared to the other groups (SCZ, p = .004; DEL, p = .003; HC, p < .001). A significant deficit in social cognition was observed in the three clinical groups. In the DEL SCZ and SCZ groups, TASIT scores significantly predicted global functioning (p < .05). Our findings of social cognition deficit in psychosis-prone patients point to the possible future adoption of rehabilitation programmes, like Social Skills Training and Cognitive Remediation, during premorbid stages of psychosis.

INTRODUCTION: Hip fracture patients are fragile, and the majority fail to fully recover to their pre-fracture functional level, resulting in an increase in institutionalization. We aimed to investigate risk factors for being dependent at discharge and for failure to return to independent living 12 months after a hip fracture.MATERIALS AND METHODS: From 2011 to 2017, all surgically treated hip fracture patients admitted from their own homes were included in this prospective cohort study. Patient characteristics were registered, including age, sex, lifestyle, comorbidities, pre-fracture New Mobility Score (NMS), biochemical measures, fracture type, and surgical method. Dependency was measured at discharge using a cumulated ambulatory score (CAS 20 s). At 12 months, patients were interviewed regarding residence, NMS, and care needs. Multivariable logistic regression was used, reporting odds ratio (OR) with 95% confidence intervals (CI).RESULTS: A total of 2006 patients were included in the study with data regarding their hospital stay and discharge. In all, 1342 patients underwent follow-up at 12 months. The risk factors found to be associated with dependency at discharge were mostly static. Modifiable variables associated with dependency at discharge (CAS CONCLUSIONS: Mobilizing patients to standing within 24 h from hip fracture surgery was vital in maximizing short-term functional recovery. Failure to return to independent living was seen in the frailest patients. However, the majority remained in their own home with little increase in care needs.

Background: The purpose of this study is to analyze the potential influence of subclinical hypothyroidism (SCH) on improvement in patient-reported outcome measures following primary total knee arthroplasty. Methods: A prospective, comparative cohort study between 92 SCH and 90 euthyroid patients was performed. Patients were followed up to 5 postoperative years. Patient-reported outcome measure was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. The Knee Society Scores were used for functional evaluation, and 5-point Likert scale for patient satisfaction. The Hospital Anxiety and Depression scale was also used. Results: All outcome scores significantly improved from preoperative to final follow-up in both groups (P = .001). There were no significant differences between groups in Knee Society Scores (P = .057) at the final follow-up, but Western Ontario and McMaster Universities Osteoarthritis Index scores were significantly lower in the SCH group (P = .015). Likewise, the patient satisfaction rate was significant lower in the SCH group (0.010). Conclusion: SCH patients have a slower functional recovery than euthyroid patients, and trended toward lower improvements in patient-reported scores. Depression was the most important negative factor. The findings of this study can provide the surgeon with an important information for better counseling the SCH patients.

Background: Laparoscopic ileal pouch-anal anastomosis (IPAA) technique is not standardized. An irregular division of the rectum could result in poor functional outcomes and residual diseased mucosa. The aim of the study was to develop a new technique for performing the rectal transection via a laparoscopic approach, and to compare the outcomes of this technique with those of the open surgery IPAA. Methods: This prospective study included all patients who underwent restorative proctectomy (following a previous subtotal colectomy) for ulcerative colitis in October 2017-November 2020. Rectal division was performed using a 30 mm open linear stapler which was applied laparoscopically across the distal rectum. Postoperative and functional outcomes, length of anal stump and completeness of mucosal removal were compared. Only the patients who had their ileostomy reversed by 31 December 2020 and, therefore, a minimum follow-up of 6months from the ileostomy closure, were included in the analysis of the functional outcomes and quality of life. Results: There were 207 patients (161 laparoscopic, 46 open). Median age was 43 (18-77) years and 85 patients (41.1%) were male. Major complications (9.3 vs. 8.7%, p = 0.89) including anastomotic leaks (3.7 vs 4.4%, p = 0.84) were similar after laparoscopic and open IPAA. Patients reported a comparable number of bowel movements during the day (6 vs. 7, p = 0.21) and at night (2 vs. 2, p = 0.66), and a similar rate of episodes of incontinence during the previous 6months (3.7 vs. 4.3%, p = 0.75). The mean Cleveland Global Quality of Life score was also similar (0.79 vs. 0.74, p = 0.35). Conclusion: Our technique is safe and reproducible, and replicates the results of the open IPAA, while maintaining the advantages of minimally invasive surgery and avoiding any kind of anal manipulation which could result in poor long-term functional outcomes.

International audience; PURPOSE: Infectious encephalitis (IE) is a severe disease which requires intensive care unit (ICU) admission in up to 50% of cases. We aimed to describe characteristics, management and outcomes of IE patients who required ICU admission. MATERIALS AND METHODS: Ancillary study focusing on patients with ICU admission within the ENCEIF cohort, a French prospective observational multicentre study. The primary criteria for outcome was the functional status at hospital discharge, categorized using the Glasgow outcome scale (GOS). Logistic regression model was used to identify risk factors for poor outcome, defined as a GOS ≤ 3. RESULTS: We enrolled 198 ICU patients with IE. HSV was the primary cause (n = 72, 36% of all IE, 53% of IE with microbiological documentation). Fifty-two patients (26%) had poor outcome at hospital discharge, including 22 deaths (11%). Immunodeficiency, supratentorial focal signs on admission, lower cerebrospinal fluid (CSF) white cells count (2 days were independent predictors of poor outcome. CONCLUSION: HSV is the primary cause of IE requiring ICU admission. IE patients admitted in ICU have a poor prognosis with 11% of in-hospital mortality and 15% of severe disabilities in survivors at discharge.

Background Endovascular thrombectomy (EVT) is standard of care for anterior circulation acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), but data on nationwide performance in routine healthcare are sparse. The study aims were to describe EVT patients with LVO AIS, analyze mortality and functional outcome, and compare results with randomized controlled trials (RCTs). Methods Data from the Riksstroke and the Swedish Endovascular Treatment of Acute Stroke Registry (RSEVAS) on pre-stroke independent patients, with LVO AIS in 2017–2019, defined as occlusion of the intracranial internal carotid artery, or the M1 or M2 segments of the middle cerebral artery, and groin puncture Results In all, 1011/2560 of RSEVAS patients matched RCT inclusion criteria. Compared with RCT data, patients were older (73 vs. 68), fewer received intravenous thrombolysis (63.1% vs. 83%), and M2 occlusions were more common (24.5% vs. 8%). 90-day survival in RSEVAS was 85.3%, 42.8% achieved good outcome and 5% had symptomatic intracerebral hemorrhage (sICH). Corresponding outcomes in RCT data were 84.7% survival, 46% good outcome, and 4.4% sICH. Functional outcome was most favorable following M2 occlusions. Conclusions EVT patients from our large real-world national dataset differed from RCT patients in several baseline factors including distribution of vascular occlusion site. However, the overall outcome of EVT in our Swedish cohort appeared to well match the pivotal trial findings.

Objective: To test 1) if the 45-second Anterior Knee Pain Provocation Test (AKPP-test) could differentiate between adolescents with patellofemoral pain (PFP) and pain-free controls and; 2) whether improvements in the AKPP-test over 12 weeks were associated with improvements in self-reported knee function and pain. Design: Prospective cohort. Patients: 151 with PFP and 50 pain-free controls (age 10–14 years). Outcomes: The AKPP-test was performed at baseline, 4- and 12-week follow-up. Pain and function were collected using Knee Injury and Osteoarthritis Outcome Score (KOOS). Results: At baseline, the AKPP-test provoked pain to a median of 5 points (IQR: 3–7) on the 0–10 Numeric Pain Rating Scale in adolescents with PFP, compared to 0 (IQR 0-0) in controls. Higher pain during the AKPP-test was associated with worse KOOS-Sport/Rec (r = −0.33, P < 0.001), worse KOOS-Pain (r = −0.47, P < 0.001), and pain intensity (worst pain last 24 hours) (r = −0.39, P < 0.001) at baseline. Improvements in the AKPP-test over 12 weeks were associated with improvements in KOOS Pain (r = 0.48, P < 0.001) and KOOS Sport/Rec (r = 0.40, P < 0.001). Conclusions: Improvements in the AKPP-test were associated with improvements in self-report knee pain and limitations in sports, suggesting the AKPP-test may be a clinically responsive test of knee pain and sporting function in adolescents with PFP.

Ankylosing spondylitis (AS) is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function. Functional impairment is significant, with spine and hip involvement, and is predominantly seen in the younger age group. Total hip arthroplasty (THA) for fused hips with stiff spines in AS results in considerable improvement of mobility and function. Spine stiffness associated with AS needs evaluation before THA. Preoperative assessment with lateral spine radiographs shows loss of lumbar lordosis. Spinopelvic mobility is reduced with change in sacral slope from sitting to standing less than 10 degrees conforming to the stiff pattern. Care should be taken to reduce acetabular component anteversion at THA in these fused hips, as the posterior pelvic tilt would increase the risk of posterior impingement and anterior dislocation. Fused hips require femoral neck osteotomy, true acetabular floor identification and restoration of the hip center with horizontal and vertical offset to achieve a good functional outcome. Cementless and cemented fixation have shown comparable long-term results with the choice dependent on bone stock at THA. Risks at THA in AS include intraoperative fractures, dislocation, heterotopic ossification, among others. There is significant improvement of functional scores and quality of life following THA in these deserving young individuals with fused hips and spine stiffness.

Background: Acetabular fractures are a rather infrequent injury. Early accounts of acetabular fractures are based on postmortem results of individuals who had experienced substantial trauma, indicating the severity of these injuries. The current study aimed to evaluate the results and functional outcome of open reduction and internal fixation in patients with complex acetabular fractures. Methods: This cross-sectional interventional study was conducted in a tertiary care hospital. The study comprised a total of n=25 individuals with the diagnosis of an acetabular fracture. The main cause of acetabular fractures was a motor vehicle accident. Surgery was used to treat every case, using plates and screws. Radiologically and functionally, the outcome was evaluated using the Modified Merle D'Aubigne Score. Patients were followed up on an average for 18 months after surgery. Results: In the cases of transverse fractures n=8 total we found excellent results in n=4(50%) cases and n=3(37.5%) cases and n=1(12.5%) cases. In the cases of transverse with the posterior wall, we found no case in the excellent category and n=3(60%) cases with good results and n=1(20%) cases with fair results, and n=1(20%) cases. An anterior column with posterior hemitransverse in n=3 out of which n=1(33.33%) with excellent results and n=1(33.33%) cases each in fair and poor results. Conclusion: We found favourable functional results can be achieved in complex acetabular fractures treated with open reduction and internal fixation. Utilizing non-extensible methods alone is sufficient to result in a satisfactory fracture reduction with fewer problems. The fractured fragments must be reduced anatomically wherever feasible, fixed tightly, and mobilized as soon as possible for improved function, which are not attainable using conservative methods., http://impactfactor.org/PDF/IJTPR/12/IJTPR,Vol12,Issue12,Article28.pdf

Background: To determine the correlation between urine loss in PAD-test after catheter removal, and early urinary continence (UC) in RP treated patients. Methods: Urine loss was measured by using a standardized, validated PAD-test within 24 h after removal of the transurethral catheter, and was grouped as a loss of &lt, 1, 1–10, 11–50, and &gt, 50 g of urine, respectively. Early UC (median: 3 months) was defined as the usage of no or one safety-pad. Uni- and multivariable logistic regression models tested the correlation between PAD-test results and early UC. Covariates consisted of age, BMI, nerve-sparing approach, prostate volume, and extraprostatic extension of tumor. Results: From 01/2018 to 03/2021, 100 patients undergoing RP with data available for a PAD-test and early UC were retrospectively identified. Ultimately, 24%, 47%, 15%, and 14% of patients had a loss of urine &lt, 1 g, 1–10 g, 11–50 g, and &gt, 50 g in PAD-test, respectively. Additionally, 59% of patients reported to be continent. In multivariable logistic regression models, urine loss in PAD-test predicted early UC (OR: 0.21 vs. 0.09 vs. 0.03, for urine loss 1–10 g vs. 11–50 g vs. &gt, 50 g, Ref: &lt, 1 g, all p &lt, 0.05). Conclusions: Urine loss after catheter removal strongly correlated with early continence as well as a severity in urinary incontinence.

BACKGROUND: Periprosthetic shoulder infection (PSI) remains a devastating complication after reverse shoulder arthroplasty (RSA). Currently, scientific data related to the management of PSI are limited, and the optimal strategy and related clinical outcomes remain unclear. Guidelines from the Infectious Diseases Society of America for the management of periprosthetic joint infection are mainly based on data from patients after hip and knee arthroplasty. The aim of this study was to evaluate whether these guidelines are also valid for patients with PSI after RSA. In addition, the functional outcome according to the surgical intervention was assessed. METHODS: An RSA database was retrospectively reviewed to identify infections after primary and revision RSAs, diagnosed between 2004 and 2018. Data collected included age, sex, indication for RSA, causative pathogen, surgical and antimicrobial treatment, functional outcome, and recurrence. RESULTS: Thirty-six patients with a PSI were identified. Surgical treatment was subdivided into débridement and implant retention (DAIR) (n = 6, 17%); 1-stage revision (n = 1, 3%); 2-stage revision (n = 16, 44%); multiple-stage revision (>2 stages) (n = 7, 19%); definitive spacer implantation (n = 2, 6%); and resection arthroplasty (n = 4, 11%). The most common causative pathogens were Staphylococcus epidermidis (n = 11, 31%) and Cutibacterium acnes (n = 9, 25%). Recurrence was diagnosed in 4 patients (11%), all of whom were initially treated with a DAIR approach. The median follow-up period was 36 months (range, 24-132 months). CONCLUSION: PSI is typically caused by low-virulence pathogens, which often are diagnosed with a delay, resulting in chronic infection at the time of surgery. Our results indicate that treatment of patients with chronic PSI with DAIR has a high recurrence rate. In addition, implant exchange (ie, 1- and 2-stage exchange) does not compromise the functional result as compared with implant retention. Thus, patients with chronic PSI should be treated with implant exchange. Future research should further clarify which surgical strategy (ie, 1-stage vs. 2-stage exchange) has a better outcome overall. ispartof: JOURNAL OF SHOULDER AND ELBOW SURGERY vol:30 issue:11 pages:2514-2522 ispartof: location:United States status: published

Aims and objectives To examine clinical and functional outcomes in patients with intra- and extra-articular distal tibial fractures treated definitively by Ilizarov fixation. Materials and methods Patients with tibial fractures extending within 1 Müller square of the ankle joint were identified from our Ilizarov database over a 5-year period. Data on treatment and outcome were assembled from this database and supplemented by a review of patient records. General measures of health–related quality of life and limb-specific functional outcome scores were recorded. Adverse events were documented according to Paley's classification. Results One hundred and sixty-eight patients with 169 fractures were identified, 28% were open and 63% intra-articular. One hundred and sixty-five (98%) of the fractures united, two following bone grafting in their original frames, at a median of 166.5 days (range 104–537). Three patients with nonunions united with further treatment. One patient (an end-stage diabetic) elected to undergo amputation following multiple early complications during treatment. Closed fractures united more rapidly than open (median 157 vs 183 days; p = 0.005) and true Pilon (43C3) fractures took longer to unite than other fractures (median 157 vs 177 days; p = 0.01). Sixty-seven percent of patients completed functional outcome scores. Sixty-two percent reported good or excellent ankle scores at more than 6 months post frame removal, 38% fair and 10% poor. Patients with intra-articular fractures reported significantly worse ankle scores than those with extra-articular injuries. General measures of health-related quality of life (EuroQol-5D) revealed significant ongoing effects despite good clinical outcomes. Conclusion This study demonstrates a high union and low serious complication rate, suggesting that external ring fixation is a safe and effective treatment for these injuries. How to cite this article Giannoudis VP, Ewins E, Taylor DM, et al. Clinical and Functional Outcomes in Patients with Distal Tibial Fracture Treated by Circular External Fixation: A Retrospective Cohort Study. Strategies Trauma Limb Reconstr 2021;16(2):86–95.

Background: Cognitive impairment is common in Parkinson’s disease (PD) and highly associated with loss of independence, caregiver burden, and assisted living placement. The need for cognitive functional capacity tools validated for use in PD clinical and research applications has thus been emphasized in the literature. The Virtual Reality Functional Capacity Assessment Tool (VRFCAT-SL) is a tablet-based instrument that assesses proficiency for performing real world tasks in a highly realistic environment. Objective: The present study explored application of the VRFCAT-SL in clinical assessments of patients with PD. Specifically, we examined associations between VRFCAT-SL performance and measures of cognition, motor severity, and self-reported cognitive functioning. Methods: The VRFCAT-SL was completed by a sample of 29 PD patients seen in clinic for a comprehensive neuropsychological evaluation. Fifteen patients met Movement Disorders Society Task Force criteria for mild cognitive impairment (PD-MCI); no patients were diagnosed with dementia. Non-parametric correlations between VRFCAT-SL performance and standardized neuropsychological tests and clinical measures were examined. Results: VRFCAT-SL performance was moderately associated with global rank on neuropsychological testing and discriminated PD-MCI. Follow-up analyses found completion time was associated with visual memory, sustained attention, and set-switching, while errors were associated with psychomotor inhibition. No clinical or motor measures were associated with VRFCAT-SL performance. Self-report was not associated with VRFCAT-SL or neuropsychological test performance. Conclusion: The VRFCAT-SL appears to provide a useful measure of cognitive functional capacity that is not confounded by PD motor symptoms. Future studies will examine utility in PD dementia.

Purpose This study examined the relationship between self-reported cognitive-behavioral flexibility scores on the Eating Disorder Flexibility Index (EDFLIX) and objective social and occupational functional milestones in participants with a lifetime diagnosis of anorexia nervosa (AN). The Work and Social Adjustment Scale (WSAS) was included to compare objective and subjective measures. Methods 114 female adult participants with a current (53.5%) or past (46.5%) full or partial AN syndrome diagnosis completed an online survey which included functional milestone questions, the EDFLIX, WSAS, EDE-Q, and DASS-21. Results Everyday flexibility scores were significantly associated with WSAS scores, but not functional milestones for the same domain. Lower flexibility was related to higher WSAS work impairment but was not associated with poor occupational outcomes. Lower flexibility was related to higher WSAS social impairment but was not associated with less frequent social contact with friends. Milestones across work, social and relationship areas were not significantly correlated, suggesting individuals have areas of strength and weakness across functional domains. In contrast, WSAS ratings indicated broad functional impairment. Conclusion Results from the milestones suggest self-reported cognitive-behavioral flexibility is not a strong determinant of everyday function. Results from the subjective WSAS function measure and the more objective functional milestones were not consistent. To obtain a more balanced assessment of everyday functioning in AN, both subjective and objective measures should be considered. Level of evidence Level III Case–control analytic study. Supplementary Information The online version contains supplementary material available at 10.1007/s40519-021-01300-7.

Purpose Improved long-term survival after low anterior resection (LAR) for rectal cancer highlights the importance of functional outcome. Urogenital and anorectal dysfunction is frequently reported after conventional LAR. Advanced minimally invasive techniques such as robotic (RoTME) and transanal total mesorectal excision (TaTME) might improve functional results by precisely dissecting and preserving autonomic nerves. We compared functional outcomes after RoTME or TaTME in a multicenter study. Methods One hundred twenty patients (55 RoTME/65 TaTME) were prospectively included in four participating centers. Anorectal (Wexner and low anterior resection syndrome (LARS) Score), urinary (International Consultation on Incontinence—Male/Female Lower Urinary Tract Symptoms Score (ICIQ-MLUTS/ICIQ-FLUTS) and International Prostate Symptom Scale (IPSS)), and sexual (International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI)) outcomes at 12 months after surgery were compared to preoperative scores. The response rate to the 1-year postoperative functional assessment by questionnaire was 79.5%. Results RoTME enabled better anorectal function compared to TaTME (LARS score 4.3 ± 2.2 vs. 9.8 ± 1.5, p = 0.038, respectively). TaTME proved superior at preserving male urinary function, while female urinary function was comparable in both groups, with only mild postoperative impairment (RoTME vs. TaTME, respectively: ICIQ-MLUTS 13.8 ± 4.9 vs. 1.8 ± 5.8, p = 0.038; ICIQ-FLUTS Incontinence Score − 0.3 ± 1.0 vs. − 0.2 ± 0.9, p = 0.844). Both techniques demonstrated comparable male (RoTME − 13.4 ± 2.7 vs. TaTME − 11.7 ± 3.4, p = 0.615) and female (RoTME 5.2 ± 4.6 vs. TaTME 10.5 ± 6.4, p = 0.254) sexual function. Conclusion After adjustment for risk factors, RoTME provided better anorectal functional results, whereas TaTME was better at preserving male urinary function. Overall, both techniques demonstrated only mild postoperative functional impairment.

Background Anterior resection (AR) may result in defecatory dysfunction and the cause is multifactorial. The aim was to explore if dysfunction could be related to the part of the colon used for anastomosis (sigmoid or descending) and to identify other possible risk factors for bowel dysfunction after AR. Methods This is a retrospective study based on prospectively registered data from a regional registry at the surgical department in Västmanland 1996–2019. Bowel function was registered at 1 year after AR or after stoma reversal. In total, 470 stage I–III rectal cancer patients had AR whereof 412 were included in this study. Results Clustering was seen in 57%, incontinence 29%, urgency 22%, and evacuatory dysfunction 16%. The part of the colon used for anastomosis, level of vascular tie, and gender were not significantly associated with defecatory dysfunction. The higher the anastomotic level, the lower the risk of incontinence (OR 0.75; CI 0.63–0.90; p p p = 0.03), incontinence (OR 2.48; 1.29–4.77; p p Conclusion The part of the colon used for anastomosis was not a significantly associated functional outcome after anterior resection. Low anastomotic level and having had a diverting ileostomy were independent risk factors associated with negative functional outcomes.

BackgroundBenefits of endovascular thrombectomy (ET) after intravenous thrombolysis (IVT) for patients with acute ischaemic stroke (AIS) have been demonstrated, but analyses of the relationship between IVT-ET time delay and functional outcomes among patients receiving both treatments are lacking.MethodsWe used data from the “Berlin—Specific Acute Treatment in Ischaemic and haemorrhAgic stroke with Long-term outcome” (B–SPATIAL) registry. Between January 1st, 2016 and December 31st, 2019, we included patients who received both IVT and ET. The primary outcome was the 3-month ordinal modified Rankin scale (mRS) score. The IVT-ET time delay was analyzed in categories and continuously. We used adjusted ordinal logistic regression to estimate common odds ratios (cOR) and 95% confidence intervals (CI). Secondary analyses involved flexible modeling of IVT-ET delay and dichotomous outcomes.ResultsOf 11,049 patients, 714 who received IVT followed by ET were included. Compared with having an IVT-ET window >120 min (reference), for an IVT-ET window < 30 min, we obtained adjusted cORs for mRS of 0.41 (95% CI: 0.22 to 0.78); and 0.52 (95% CI: 0.33 to 0.82) for 30 to 120 min. Secondary analyses also found protective effects of shorter time delays against “poor” functional outcomes at 3 months.ConclusionsIn patients with AIS, shorter IVT-ET intervals were associated with better 3-month functional outcomes. While the time-to-IVT and time-to-ET include the time until medical attention is received, the IVT-ET time delays fall entirely within the domain of medical management and thus might be easier to optimize.

Kyphoplasty with the SpineJack system was able to restore vertebral height and stabilize the vertebra with an injection of bone cement. The goal of this study was to seek a reliable assessing method during the surgery in determining the minimum amount of bone cement required for the SpineJack system to restore vertebral height and stabilize the vertebra. We defined the “double cross sign” as bone cement that expanded vertically along the bilateral SpineJack system, and spread across the midline of the vertebral body as viewed in the anteroposterior (AP) view of the radiographic image. Sixty-five patients aged 74.5 ± 8.5 years with vertebral compression fracture were included in the study. Patients with a positive double cross sign had better ODI score than those without the double cross sign (20.0 ± 6.9 vs. 32.3 ± 8.2; p < 0.001). Postoperative regional kyphotic and local kyphotic angle were significantly better in the positive double cross sign group (11 ± 8.8 degrees vs. 5.3 ± 3.2 degrees; p = 0.001/11.7 ± 6.2 degrees vs. 6.6 ± 4.1 degrees; p = 0.001, respectively). The more stable construct was built once the double cross sign was achieved during surgery. In this study, a convenient and intuitive method in identifying the minimum but sufficient quantity of injected cement during the SpineJack procedure was developed.

OBJECTIVE: To investigate the effect of progressive resistance exercise compared with low-intensity home-based exercises on knee-muscle strength and joint function in people with anterior cruciate ligament (ACL) reconstruction and persistent hamstring strength deficits at 12–24 months after surgery. DESIGN: Randomized controlled superiority trial with parallel groups, balanced randomization (1:1), and blinded outcome assessment. METHODS: People with ACL reconstruction (hamstring autograft) and persistent hamstring muscle strength asymmetry were recruited 1 to 2 years postsurgery and randomized to either 12 weeks of supervised progressive strength training (SNG), or 12 weeks of home-based, low-intensity exercises (CON). The primary outcome was between-group difference in change in maximal isometric knee flexor muscle strength at 12-week follow-up. RESULTS: Fifty-one participants (45% women, 27 ± 6 years) were randomized to SNG (n = 25) or CON (n = 26), with 88% follow-up rate at 12 weeks. People in the SNG group improved their knee flexor muscle strength (0.18 N·m/kg, 95% confidence interval [CI]: 0.07, 0.29; P = .002) more than the CON group, from baseline to 12 weeks. The SNG group also had superior Knee Injury and Osteoarthritis Outcome Scores for Pain (4.6, 95% CI: 0.4, 8.7; P = .031) and daily living function (4.7, 95% CI: 1.2, 8.2; P = .010) compared to the CON group. CONCLUSION: In people with persistent hamstring muscle strength deficits after ACL reconstruction, 12 weeks of supervised progressive strength training was superior to low-intensity home-based exercises for improving maximal knee flexor muscle strength and some patient-reported outcomes. J Orthop Sports Phys Ther 2023;53(1):40–48. Epub: 17 October 2022. doi:10.2519/jospt.2022.11360

BackgroundSurgical resection offers survival benefits in patients with diffuse low-grade glioma (DLGG) but its association with functional outcomes is uncertain. This systematic review assessed functional outcomes associated with extent of resection (EoR) in adults with DLGG.MethodsWe searched Medline, Embase and CENTRAL on the 19th of February 2021 for observational studies reporting functional outcomes after surgical resection for patients aged ≥18 years with a new diagnosis of supratentorial DLGG according to any World Health Organization classification of primary brain tumors. The Newcastle-Ottawa Scale (NOS) informed our risk of bias assessments. The proportion of patients returning to work within 12 months entered a random-effects meta-analysis. PROSPERO registration number CRD42021238387.ResultsThere were seven eligible moderate to high-quality (NOS >6) observational studies identified from 1,183 records involving 234 patients with DLGG. Functional outcomes reported included neurocognition (n=2 studies), performance status (n=3), quality of life (QoL) (n=1) and return to work (n=6). The proportion of patients who returned to work within 12 months of surgery was 84% (95% confidence interval [CI] 50-96%, I-squared=38%, 5 studies) for gross total resection, 66% (95% CI 14-96%, I2=57%, 5 studies) for subtotal resection, and 31% (95% CI 4-82%, I2= 0%, 4 studies) for partial resection. There was insufficient data on other functional outcomes for quantitative synthesis.ConclusionA higher proportion of DLGG patients returned to work following gross total resection compared with those who had a subtotal or partial resection. Further studies with standardized assessments can clarify the association between EoR and different functional outcomes.Importance of the StudyThe association between lower residual tumor volume and better survival in people with diffuse low-grade glioma (DLGG) has driven surgical research into maximizing resection. However, innovative interventions should be evaluated against both oncological outcomes and functional outcomes. This systematic review included all studies reporting post-operative functional outcomes stratified by the extent of resection in people aged ≥18 years with DLGG. Two studies reported neurocognition, three reported performance status, one reported quality of life, and six reported return-to-work. Our meta-analysis demonstrated a higher proportion of patients returning to work within 12 months for those who had gross total resection (84%) compared to subtotal (66%) and partial (31%) resections. Our results suggest that increased EoR may be associated with return-to-work, but direct comparative studies should verify this finding and could examine other important functional outcomes.Key PointsSeven studies reported functional outcomes stratified by EoR in DLGG patients.Return-to-work (RTW) was the most reported functional outcome.84% undergoing GTR of DLGG RTW within 12 months compared to STR (66%) or PR (31%).

Objective Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is the core medical therapy of acute ischaemic stroke (AIS). COVID‐19 infection negatively modifies acute stroke procedures and, due to its pro‐coagulative effect, may potentially impact on IVT outcome. Thus, short‐term efficacy and safety of IVT were compared in patients with and without evidence of SARS‐CoV‐2. Methods An observational, retrospective study included 70 patients with AIS, including 22 subjects (31%) with evidence of acute COVID‐19 infection, consecutively treated with IVT in 4 stroke centres between 15 September and 30 November 2020. Results Patients infected with COVID‐19 were characterized by higher median of National Institute of Health Stroke Scale (NIHSS) score (11.0 vs. 6.5; p

Introduction Over the last decade rectus diastasis has gained attention as a condition that may benefit from surgery. Numerous surgical techniques have been presented but scientifically proper studies reporting functional outcome are few and evidence is incomplete. The aim of this up-to-date review is to analyse the outcomes of rectus diastasis repair in recently published papers, focusing on functional changes following surgery. Method A comprehensive search in PubMed and Web of Science was performed. Suitable papers were selected using titles and abstracts with terms suggesting surgical treatment of rectus diastasis. All abstracts were scrutinised, and irrelevant studies excluded in four stages. Reports providing original data, including outcome assessment following surgery, were included. Result Ten papers with a total of 780 patients were found to fulfil the search criteria. Study design, surgical procedure, follow-up time, functional outcome and assessment instruments were compiled. All included studies reported improvements in a variety of functional aspects regardless of surgical method. The outcomes assessed include core stability, back pain, abdominal pain, posture, urinary incontinence, abdominal muscle strength and quality of life. Conclusion The results of this review show that surgical repair of rectus diastasis is a safe and effective treatment that improves functional disability. However, the absence of standardized instruments for assessing outcome makes it impossible to compare studies. Since indications for surgery are relative and related to core function, valid instruments for assessing indication and outcome are needed to ensure benefit of the procedure.

INTRODUCTION: Approach to the management of displaced acetabular fractures has evolved from conservative to operative management after the work of Judet and Letournel. Various surgical methods have been explored and described by authors to address this type of fracture, leading to improved clinical outcome. This study aimed to evaluate functional outcome of surgically treated displaced acetabular fractures in the Malaysian context. MATERIALS AND METHODS: We analysed 43 patients with isolated acetabular fractures who were treated operatively with a minimum of three years follow-up. Anthropometric data, Judet-Letournel fracture pattern, surgical approach and complications were recorded. Post-operative Matta radiological outcome were evaluated for joint congruency and hip functional outcome was evaluated using Merle d’Aubgine-Postel and Harris Hip Score (HHS). All statistical analyses were analysed using SPSS version 24.0. RESULTS: The most frequent elementary fracture type was posterior wall (30.2%) while associated type was both columns (23.3%). Mean functional outcome of Merle d'Aubigné-Postel was 15.77 and HHS was 86.6. Thirty-three (76.7%) patients achieved satisfactory functional outcome, 19 (44.1%) patients achieved anatomic reduction (

Background: Osteoarthritis of knee is one of the common conditions seen in older individuals and known to affect quality of life considerably. It makes it difficult for individuals with knee osteoarthritis to climb stairs, walk long distances, and stand for long time and squatting. In intractable cases not responding to conservative management surgical management such as proximal fibular Osteotomy (PFO) or high tibial Osteotomy (HTO) is routinely done. We conducted this comparative study to analyse the functional outcome of patients who had undergone HTO and PFO for medial compartment osteoarthritis of knee joint. Aims and Objectives: 1) To analyse the functional outcome of patients who had undergone HTO and PFO for medial compartment osteoarthritis of knee joint. 2) To compare complication rates in both the groups. Materials and Methods: A total of 60 patients with medial compartment knee osteoarthritis were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were randomized to 2 groups. Thirty patients undergoing proximal fibular osteotomy (Group A) and 30 patients undergoing high tibial osteotomy (Group B). The patients were followed up for improvements in functional outcome for 12 months. The statistical analysis was done using SSPS 21.0 software and p value less than 0.05 were taken as statistically significant. Results: Mean time for surgery was less for PFO surgery as compared to HTO and the difference was statistically significant. Moreover mean bleeding amount, drainage volume and time required for full weight bearing was low in PFO group as compared to HTO group and the difference was found to be statistically significant (P

We are performing a systematic review of all studies that report quality of life outcomes for patients who had in-hospital cardiac arrest and have received CPR in hospital.

Background and Objectives: Thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA) is used to treat acute ischemic stroke. Dabigatran is a reversible thrombin inhibitor approved for stroke prevention in patients with nonvalvular atrial fibrillation. In such cases, thrombolytic therapy can be administered to certain patients after idarucizumab treatment. We evaluated the effectiveness of idarucizumab in dabigatran-treated patients receiving rt-PA. Materials and Methods: We included the data of nine idarucizumab-treated patients from the Riga East University Hospital Stroke Registry from 2018 to 2022 in our retrospective medical records analysis. We used the National Institutes of Health Stroke Scale (LV-NIHSS) score and modified Rankin scale (mRS) on admission and discharge to evaluate neurological deficit and functional outcomes. Results: We analyzed the data of nine patients (seven males and two females) with a mean age of 75.67 ± 8.59 years. The median door-to-needle time for all patients, including those who received idarucizumab before rt-PA, was 51 min (IQR = 43–133); the median LV-NIHSS score was 9 (IQR = 6.0–16.0) on admission and 4 (IQR = 2.5–4.0) at discharge; and the intrahospital mortality rate was 11.1% due to intracranial hemorrhage as a complication of rt-PA. Conclusions: Our study shows that idarucizumab as an antidote of dabigatran appears to be effective and safe in patients with acute ischemic stroke. Furthermore, the administration of idarucizumab slightly prolongs the door-to-needle time; however, the majority of cases showed clinical improvement after receiving therapy. Further randomized controlled trials should be performed to evaluate the safety and effectiveness of idarucizumab for acute ischemic stroke treatment.

Background and AimsThe visibility of ischaemic brain lesions on non-enhanced CT increases with time. Obviously hypoattenuating lesions likely represent infarction. Conversely, viable ischaemic brain lesions may be non-visible on CT. We tested whether patients with normal appearing ischaemic brain tissue (NAIBT) on their initial CT are identifiable, and if NAIBT yields better outcomes with alteplase.MethodsWith data from the Third International Stroke Trial (IST-3, a large randomized-controlled trial of intravenous alteplase for ischaemic stroke) we used receiver-operating characteristic analysis to find a baseline National Institutes of Health Stroke Scale (NIHSS) threshold for identifying patients who developed medium-large ischaemic lesions within 48 h. From patients with baseline CT (acquired ResultsFrom 2,961 patients (median age 81 years, median 2.6 h from stroke onset, 1,534 [51.8%] female, 1,484 [50.1%] allocated alteplase), NIHSS>11 best identified those with medium-large ischaemic lesions (area under curve = 0.79, sensitivity = 72.3%, specificity = 71.9%). In IST-3, 1,404/2,961 (47.4%) patients had baseline CT and NIHSS>11. Of these, 745/1,404 (53.1%) had visible baseline ischaemic lesions, 659/1,404 (46.9%) did not (NAIBT). Adjusted odds ratio for favorable outcome after alteplase was 1.54 (95% confidence interval, 1.01–2.36), p = 0.045 among patients with NAIBT vs. 1.61 (0.97–2.67), p = 0.066 for patients with visible lesions, with no evidence of an alteplase-NAIBT interaction (p-value = 0.895).ConclusionsPatients with ischaemic stroke and NIHSS >11 commonly develop sizeable ischaemic brain lesions by 48 h that may not be visible within 6 h of stroke onset. Invisible ischaemic lesions may indicate tissue viability. In IST-3, patients with this clinical-radiological mismatch allocated to alteplase achieved more favorable outcome than those allocated to control.

Objective: To assess the effects of dextrose prolotherapy in patients with knee osteoarthritis on the levels of serum cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen, and on the Western Ontario McMaster Universities Index and numerical rating scale score for pain. Methods: A randomized controlled trial, in which participants were randomly allocated into 2 groups, receiving injections of either hyaluronic acid or dextrose prolotherapy. The hyaluronic acid group received 5 injections, 1 each on weeks 1, 2, 3, 4 and 5, and the dextrose prolotherapy group received 3 injections, 1 each on weeks 1, 5 and 9. Serum cartilage oligomeric proteinase, urinary C-terminal telopeptide of type II collagen, Western Ontario McMaster Universities Index score, and numerical rating scale score for pain were measured at baseline and 3 weeks after the last injection. Comparative analysis was conducted using Wilcoxon test within groups and analysis of covariance (ANCOVA) test between groups. Results: A total of 47 participants (21 allocated to hyaluronic acid, 26 allocated to dextrose prolotherapy) completed the protocol. Both interventions resulted in significant improvements in numerical rating scale scores for pain, total Western Ontario McMaster Universities Index scores, and its subscales score. However, the dextrose prolotherapy outperformed hyaluronic acid in numerical rating scale score for pain and level of urinary C-terminal telopeptide of type II collagen, with score changes differences of 0.93 (p?=?0.042) and 0.34 (p?=?0.048), respectively. No significant changes in level of serum cartilage oligomeric proteinase were found in either group. Conclusion: Dextrose prolotherapy is an alternative injection therapy for knee osteoarthritis, which was found to be associated with a significant reduction in urinary C-terminal telopeptide of type II collagen compared with hyaluronic acid injection. Neither injection method resulted in reduced serum cartilage oligomeric proteinase.

Objective To explore the effect of frailty, alone and in combination with post‐operative delirium (POD), on the risk of poor function at discharge in patients with hip fracture (HF). Methods This is a prospective cohort study of patients with HF admitted to an Orthogeriatric Unit (OGU) between October 1, 2011 and March 15, 2019. POD was assessed using the 4AT and the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5‐edition criteria. A 22‐items Frailty Index (FI) was created using the data collected on admission. The outcome measure was the Cumulated Ambulation Score (CAS) score at discharge. A log‐binomial regression model was used to assess the effect of frailty and POD on CAS. Results A total of 988 patients (median age = 84.9 years, Interquartile range = 80.6‐89.2) were included: 360 patients (36.4%) were frail and 411 (42%) developed POD. Poor functional status at discharge (CAS score ≤2) was more common in frail than non‐frail patients (68.3% vs. 53.8%, p, Key Points Studies that investigate the joined effect of frailty and post‐operative delirium (POD) on functional outcome of hip fracture (HF) patients after surgical repair are lackingIn this prospective cohort study on 988 older patients with HF, we demonstrated that frailty, POD and their combination are associated with poor functional status at discharge from an Orthogeriatric UnitAssessing frailty could help early detecting the onset of POD, promoting its prevention and reducing the negative impact on function at dischargeThe results of this study emphasize the need to improve geriatric knowledge across hospitals that assist older patients with HF

Purpose To evaluate functional outcomes of severe traumatic brain injuries after insertion of intracranial pressure (ICP) monitor at King Saud Medical City (KSMC) and their correlation to each other. Patients and Methods A retrospective observational study for all adult patients (age >18 years) who were diagnosed with severe head injury and underwent ICP insertion at KSMC. Patients diagnosed between 2017 and 2019 were included. Data for measured outcomes, Glasgow outcome scale (GOS), Karnofsky Performance Score (KPS) and length of stay (LOS) and prognostic factors, data like: age, gender and primary Glasgow coma score (GCS) was obtained from patients’ files and direct communication with patients or their caregivers. We also compared patients who underwent ICP monitoring alone with those who underwent ICP with decompressive craniectomy (DC). Follow-up period ranged from 6–24 months. Results Seventy-four patients were included in this cohort study. Outcome measurements for patients with decompression and ICP were lower than those with ICP alone. KPS and GOS showed strong correlation (p

Background: Distal femur fractures are generally due to high velocity trauma particularly form road traffic accidents and fall from height. The treatment of distal femur fractures has evolved from conservative to operative to fixation of both lateral and medial columns of femur. Aims and Objective: The aim of this study was to evaluate the functional outcome of operated cases of comminuted fracture of lower end of femur fixed with locking compression plate laterally and augmented with titanium elastic nail system medially. Materials and Methods: The present study was a prospective study carried out in Bharati Vidyapeeth Medical College and Hospital, Sangli after approval from institutional ethical committee. In this study, 20 patients with communited fracture of lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and clinical examination was done in all cases. After preanesthetic evaluation and relevant investigations patients were treated by reduction (close or open) and fixation was done by locking compression plate laterally and augmented with titanium elastic nail system medially. Patients were followed up at 6, 10 and 14 weeks for functional outcome by Neer’s scoring system and degree of flexion at knee joint. Results: Out of 20 studied cases there were 16 (80%) males and 4 (20%) were females with a M:F ratio of 4:1. The mean age of male patients was found to be 42.81+/-14.79 whereas mean age of female patients was 40.5 +/- 14.36. The mean age of male and female patients was found to be comparable with no statistically significant difference (P=0.78). Most of the patient were diagnosed with the fracture of AO TYPE C3 (7 cases), followed by AO TYPE C1 (4 cases). Full weight bearing was achieved in 8 (40%) patients within 18 weeks whereas remaining 12 (60%) patients required more than 20 weeks for full weight bearing. 14 (70%) patients had excellent outcome whereas, Good, Fair and poor outcomes were seen in 4 (20%), 1 (5%) and 1 (5%) patient. On one-way ANOVA analysis, showed that the flexion was significantly higher in 12 weeks as that of the 6 weeks (P =

Tomiki Sumiyoshi,1 Koichiro Watanabe,2 Shinichi Noto,3 Shigeru Sakamoto,4 Yoshiya Moriguchi,5 Lene Hammer-Helmich,6 Jovelle Fernandez4 1Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; 2Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan; 3Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan; 4Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan; 5Medical Affairs, Lundbeck Japan KK, Tokyo, Japan; 6Medical Affairs Value Evidence, H. Lundbeck A/S, Valby, DenmarkCorrespondence: Tomiki SumiyoshiDepartment of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, JapanTel +81 42 341 2711Fax +81 42 346 3569Email sumiyot@ncnp.go.jpBackground: Accumulating evidence suggests the presence of cognitive impairment in patients with major depressive disorder (MDD), which affects their psychosocial function and quality of life (QoL). PERFORM-J (Prospective Epidemiological Research on Functioning Outcomes Related to MDD in Japan) is an observational, multicenter study to assess longitudinal changes in depressive symptoms, psychomotor speed, subjective cognitive function, and psychosocial function.Methods: Five hundred and eighteen Japanese outpatients with MDD initiating new antidepressant monotherapy (first-line or switch from previous drug) as part of their routine medical care participated in this study. Assessments at baseline and over the 6-month observation period included physician-rated depression severity (Montgomery–Åsberg Depression Rating Scale), psychomotor speed (Digit Symbol Substitution Test; DSST), subjective cognition (Perceived Deficits Questionnaire–Depression), psychosocial function (Sheehan Disability Scale), and QoL (EuroQol-5 Dimension-5 Level).Results: Antidepressant treatment for 6 months improved depressive symptoms and subjective cognitive impairment (cognitive complaints), whereas psychomotor speed remained impaired (ie, DSST total score was > 1 standard deviation below the norm) in 35.6% of patients at 6 months. Impairment of subjective cognition, but not psychomotor speed at month 2 was associated with poor psychosocial function and QoL at 6 months. There was a trend for higher relapse rates at 6 months in patients with greater subjective cognitive impairment at 2 months.Conclusion: These findings highlight the importance of evaluating cognitive difficulties to predict long-term outcomes in patients with MDD. Early intervention for cognitive complaints may decrease the relapse rate, which warrants further study.Keywords: cognition, depression, functional outcome, quality of life, Japan

© 2021, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA). Purpose: Chronic grade 3 tears of the medial collateral ligament and posterior oblique ligament may result in valgus laxity and anteromedial rotational instability after an isolated or multiligament injury. The purpose of this study was to prospectively analyze the restoration of physiologic medial laxity as assessed on stress radiography and patient reported subjective functional outcomes in patients who undergo an anatomic medial knee reconstruction. Methods: This was a prospective study which included patients with chronic (> 6 weeks old) posteromedial corner injury with or without other ligament and meniscus lesions. Pre- and post-operative valgus stress radiographs were performed in 20° knee flexion and functional outcome was recorded as per the International Knee Documentation Committee (IKDC) and Lysholm scores. All patients underwent anatomic medial reconstruction with two femoral and two tibial sockets using ipsilateral hamstring tendon autograft. Simultaneous ligament and meniscus surgery was performed as per the associated injury pattern. All patients were followed up for a minimum of 24 months post-surgery. Results: Thirty-four patients (23 males, 11 females) were enrolled in the study and all were available till final follow-up of mean 49.7 ± 14.9 months. The mean age was 30.6 ± 7.9 (18–52 years). Two patients had isolated medial sided lesions and 23 had associated ligament injuries. The mean follow up was 49.7 (24–72) months. The mean IKDC score improved from 58 ± 8.3 to 78.2 ± 9.5 (p < 0.001). Post-operatively there were 15 excellent, 11 good and 8 fair outcomes on Lysholm score. The mean pre-operative valgus side-to-side opening improved from 7.5 ± 2.5 mm to 1.2 ± 0.7 mm on stress radiography (p < 0.001). Conclusion: Anatomic reconstruction of the superficial medial collateral and posterior oblique ligaments restore stability in a consistent manner cases of chronic grade 3 instability. The objective functional results, subjective outcomes and measures of static medial stability are satisfactory in the short term. Level of Evidence: IV

The article presents the results of a retrospective study that included 70 patients with intraarticular (AO Type C [Arbeitsgemeinschaft für Osteosynthesefragen]) distal radius fractures, who were treated using an arthroscopically assisted approach with volar locking plates or just a fluoroscopically assisted surgery. Thirty-seven of them were treated using volar locking plates using only fluoroscopically guided surgery and 33 patients were treated with the arthroscopically assisted fracture fixation method. Data of the patients who attended a full cycle of the postoperative observation within the first year after the surgery and postponed to the last visit 1 to 5 years after the surgery were included in the analysis for both groups. Postoperative analysis was carried out using X-ray assessment, clinical data, patient-rated wrist evaluation score, Gartland and Werley score, Modern Activity Subjective Survey of 2007 score, range of motion, grip, pinch and tripod pinch assessment at 1, 3, 6 and 12 months postoperatively. Despite the statistically significant differences found in a number of parameters during the follow-up period, there were no clinically relevant differences determined between the two methods in the long-term period. There was a greater arch of motions in extension and radial deviation in the arthroscopic surgery group. Duration of the surgery was longer in the arthroscopic surgery group, but comminuted or AO-C3 type fractures also were more often presented in this group. One complex regional pain syndrome occurred in the arthroscopic surgery group and two in the control group. None of patients suffered tendon ruptures, hardware migration or infections.

Objectives In this study, we present our 10-year postoperative follow-up results of Sanat Swing® and NexGen® total knee implants. Patients and methods A total of 189 patients (93 males, 96 females; mean age: 68 years; range, 48 to 86 years) who underwent total knee replacement between January 2008 and September 2010 were retrospectively analyzed. A total of 105 patients (Group A) were implanted a cemented Sanat Swing knee prosthesis and 84 patients (Group B) were implanted a cemented NexGen knee prosthesis. Operation time, range of motion (ROM), pain level, Knee Society Score (KSS), distance of painless walking, and the ability to climb stairs were evaluated between the groups. Results The mean follow-up was 10.8 (range, 9.8 to 12.3) years. No significant difference was observed in the survival of the prostheses, ROM, pain level, KSS, walking distance, and in the ability to climb stairs between the two groups at 10 years. With an experienced team, the operation time was about 4 to 5 min shorter in the Sanat Swing implantation group. In selected cases, Sanat Swing was superior to the NexGen system; however, there was no statistically significant difference. Complication rates were also low and comparable between both groups. Conclusion Based on the 10 years of follow-up evaluation, Sanat Swing total knee replacement system seems to yield comparable clinical results with the NexGen. Experiences with the operative technique and comparative evaluation, the Sanat Swing system is a safe and reliable alternative for total knee replacement, providing a user-friendly operative technique and shorter operation time.

Aim of the work To study the effect of education on rheumatoid disease in a cohort of Egyptian patients. Patients and methods This study included 1022 consecutive rheumatoid arthritis (RA) patients recruited from several rheumatology clinics of public and private sectors from Cairo, Kafr Elsheik and Fayoum governorates. Their mean age was 45.1 ± 12.4 years and mean disease duration was 85.9 ± 73 months. Patients were divided into groups according to their educational level (university degree/high school/illiterate) and were compared regarding their disease activity score (DAS28) and modified health assessment questionnaire (mHAQ) as a measure of the functional status. Results The mean age of patients was 45.1 ± 12.4 years, they were 854 females and 168 males and disease duration of 85.9 ± 73 months. 106 (10.4%) were smokers and 333 (32.6%) were employed. 342 (33.5%) were illiterate, 455 (44.5%) were non-university-educated and 225 (22%) university educated. Educated patients showed significant lower disease activity (p = 0.001), swollen joint count (p = 0.044), tender joint count (p = 0.001), doctors global assessment (p = 0.001), erythrocyte sedimentation rate (p = 0.003) and visual analogue scale (p = 0.001). Educated patients had significantly received more biologic therapy (p = 0.001) and attended regular follow-up (p = 0.001). They showed better functional status with significantly lower MHAQ and had significant higher percentage of employment (p = 0.001). Rheumatoid patients with a university degree had significantly lower diseases activity and better functional indices compared to those without. Further regression analysis showed that university education is a predictor for low disease activity. Conclusion Rheumatoid disease is influenced by education among Egyptians. Higher educated patients had lower disease activity and better functional outcome, and university education predicts low disease activity among Egyptian RA patients.

Contains fulltext : 244274.pdf (Publisher’s version ) (Open Access) Radical cystectomy (RC) is the treatment of choice and is strongly recommended for patients with pT2-4aN0M0 bladder cancer in both the European Association of Urology (EAU) and American Urological Association (AUA) muscle-invasive bladder cancer (MIBC) guidelines. RC is a challenging operation, with significant perioperative and postoperative morbidity and mortality, having short-term complication rates between 14.4% and 21.7%, and long-term oncological survival rates ranging from 60% after 5 years to 43% after 10 years. The impact on quality of life (QoL) in patients after treatment for bladder cancer is significantly worse than in other pelvic cancers. Although RC is strongly recommended as the gold standard, there is a need for bladder-sparing options in MIBC. Attempts to improve mortality and morbidity rates after RC have been made by implementing Enhanced Recovery After Surgery (ERAS), robot-assisted RC, and sexual function-preserving techniques. None of these significantly improves QoL or functional outcome. Because of the invasiveness of RC, other therapeutic options have been evaluated. Transurethral resection of the bladder tumor (TURB) plays an important role in the diagnostic evaluation of MIBC and has also been reviewed as a curative option, although the oncological results appear inferior to RC. Furthermore, improved radiotherapy (RT) and widely used chemotherapy, both as monotherapeutic options in bladder cancer, are not as effective as radical surgery, with lower survival rates. Trimodality treatment (TMT) in bladder cancer combines TURB with chemotherapy and RT. The goal of TMT is preserving the bladder and QoL without compromising oncological outcome. A 2018 review showed no difference in overall survival rates between RC and TMT (30.9% vs 35.1%), with lower survival rates after RC than TMT in the first year of follow-up, probably due to higher postoperative mortality. For a selected group of patients, TMT is to be recommended, and it is the most favorable option out of the organ-sparing strategies in MIBC.

Purpose: To investigate functional outcomes and quality of life (QoL) after restorative proctocolectomy (RPC) using transanal minimal invasive surgery (TAMIS). Method: The study consists of two sub-studies. A cohort study comprised 98 consecutive patients, who underwent TAMIS RPC. These patients were the first at our department to undergo TAMIS RPC. We collected information about surgery, complications, postoperative morbidity and mortality ≤ 30 days, and pouch problems. Patients were also invited to participate in a case–control study in which the patients would respond to three different questionnaires, the Inflammatory Bowel Disease Questionnaire (IBDQ), the Short Form-36 General Health Questionnaire (SF-36), and questions from the Pouch Dysfunction Score. We compared the responding TAMIS RPC patients to a Danish national cohort (0–10 years from RPC, n = 514) of patients having RPC between 1980 and 2010. We compared functional outcomes and QoL. Results: Four (4%) of the TAMIS patients had an anastomotic leak; none of these required re-operation with removal of the pouch. Anastomotic leak was treated with antibiotics and drain. Out of the four leaks, only one ended up with a permanent stoma; all others had their stoma reversed successfully. The TAMIS patients had the same number of bowel movements as the patients in the Danish national cohort study. The same was seen with regard to incontinence. We had no conversions in our series of TAMIS procedures. Conclusion: The TAMIS technique shows acceptable outcomes, both in regard to postoperative complications and also functional outcome and QoL.

Background: Patients with metastatic spinal cord compression (MSCC) may experience long-term functional impairment. It has been established that surgical decompression improves neurological outcomes, but the effect of early surgery remains uncertain. Our objective was to evaluate the impact of early versus late surgery for acute MSCC due to spinal metastases (SM). Methods: We retrospectively reviewed a consecutive cohort of all patients undergoing surgery for SMs at our institution. We determined the prevalence of acute MSCC; the time between acute neurological deterioration as well as between admission and surgery (standard procedure: decompression and instrumentation); and neurological impairment graded by the ASIA scale upon presentation and discharge. Results: We screened 693 patients with surgery for spinal metastasis; 140 patients (21.7%) had acute MSCC, defined as neurological impairment corresponding to ASIA grade D or lower, acquired within 72 h before admission. Non-MSCC patients had surgery for SM-related cauda equina syndrome, radiculopathy and/or spinal instability. Most common locations of the SM in acute MSCC were the thoracic (77.9%) and cervical (10.7%) spine. Per standard of care, acute MSCC patients underwent surgery including decompression and instrumentation, and the median time from admission to surgery was 16 h (interquartile range 10–22 h). Within the group of patients with acute MSCC, those who underwent early surgery (i.e., before the median 16 h) had a significantly higher rate of ASIA improvement by at least one grade at discharge (26.5%) compared to those who had late surgery after 16 h (10.1%; p = 0.024). Except for a significantly higher sepsis rate in the late surgery group, complication rates did not differ between the late and early surgery subgroups. Conclusions: We report data on the largest cohort of patients with MSCC to date. Early surgery is pivotal in acute MSCC, substantially increasing the chance for neurological improvement without increasing complication rates. We found no significant impact when surgery was performed later than 24 h after admission. These findings will provide the framework for a much-needed prospective study. Until then, the treatment strategy should entail the earliest possible surgical intervention.

Background and aim Fecal incontinence and/or evacuation difficulty are common after ileoanal pouch surgery. This study aimed to determine whether the development of these symptoms can be predicted so that preventive measures might be instituted. Methods A consecutive series of 46 patients with ulcerative colitis (median age at surgery, 41 years; 50% female) and a functioning pouch for a duration ≥12 months was included. Assessment utilized medical record review and questionnaires on pre‐ and postoperative bowel function, quality of life, and psychological well‐being. Pouch function was assessed by the Colorectal Functional Outcome score (0 = no impairment, 100 = worst impairment). Good pouch function was defined as a score ≤24. Results Fecal incontinence occurred in 67% preoperatively and 54% postoperatively; evacuation difficulty occurred in 65% and preoperatively and 85% postoperatively. The postoperative median Colorectal Functional Outcome score was 20 (range 2–74), with 44% of patients >24 (poor pouch function). Preoperative nocturnal fecal incontinence (odds ratio [OR] 4.92, 95% confidence interval [CI] 1.2–19.4, P = 0.02) and pouchitis (OR 5.41, 95% CI 1.2–23.7, P = 0.02) were associated with poor pouch function after multivariable regression analysis. Postoperative satisfaction, psychological well‐being, and quality of life were significantly better in those with good pouch function, while poor sleep, impaired work, and sexual dysfunction were independently associated with poor pouch function. Conclusions Functional bowel symptoms are common before and after pouch surgery and are associated with the impairment of patient‐reported outcomes. Preoperative nocturnal fecal incontinence predicts poor pouch function. Therapeutic focus on continence, bowel evacuation, psychological well‐being, and quality of life should begin before surgery., In this consecutive series of 46 patients, with a functioning pouch for ulcerative colitis, high rates of fecal incontinence and evacuation difficulty were reported by patients preoperatively. After pouch creation, the rate of fecal incontinence decreased, and evacuation difficulty increased. Postoperative satisfaction, psychological well‐being, and quality of life were significantly better in those with good pouch function, highlighting the importance of recognizing symptoms early and providing appropriate treatment.

Spinal dural arterio-venous fistulas (SDAVF) are rare vascular pathologies. Degree of symptom improvement after surgery remains unclear. We evaluated surgically treated SDAVF patients for functional outcome and symptom improvement. Retrospective inclusion of consecutive patients treated surgically in our department between 2007&ndash, 2019. We measured functional outcome using the McCormick Scale and modified Japanese Orthopaedic Association (mJOA) score. We included 27 patients with a median follow-up of 8.8 months (IQR 27.8). Mean age was 61.8 years (SD 8.4), 40.7% were female. Most frequent location was the thoracic spine in 15 (55.6%) followed by lumbar in 8 (29.6%), cervical in 3 (11.1%) and sacral spine in one patient (3.7%). Most common presenting symptom was progressive myelopathy (24/27 patients, 88.9%). In all patients the SDAVF was completely resected, however, four patients (14.8%) required a second surgery. Six patients (22.2%) deteriorated immediately after surgery with five recovering to baseline upon discharge. On discharge, presenting symptoms had improved in 17 patients (63%), 8/25 patients (32%) had a McCormick score of 1. Twenty (74.1%) continued to improve on follow-up. In total 23/27 patients (85.2%) improved. In the univariable analysis mJOA score on admission was associated with mJOA score on follow-up (coefficient 0.6, 95%CI 0.4&ndash, 0.81, p &lt, 0.001), whereas age was inversely associated (coefficient &minus, 0.1, 95%CI &minus, 0.19&ndash, 0.01, p = 0.08). Untreated SDAVF leads to progressive myelopathy which may result in considerable disability. Surgical disconnection and resection provides a safe treatment option with low perioperative morbidity and excellent chances for symptom improvement or progression prevention.

Objective To gain a better understanding of the traumatic mechanism and to develop appropriate treatment for dislocation of the shoulder joint with an ipsilateral humeral shaft fracture. Methods This was an observational and descriptive study. Nine patients with traumatic shoulder dislocations associated with ipsilateral humeral shaft fractures who visited the emergency room and received treatment from January 2012 to June 2018 were retrospectively analyzed. CT with three‐dimensional reconstruction was performed to provide precise anatomical information of the fractures. The traumatic event and the type of fracture of the humeral shaft were analyzed to help determine the trauma mechanism. Closed reduction of the dislocation was attempted at once under intravenous anesthesia. One patient died the following day due to unrelated causes. All humeral shaft fractures of the eight patients received internal fixation, and then reduction of the dislocation was performed again if previous attempts failed. The affected limb was immobilized in a sling for 3 weeks postoperatively, and then active and passive movement was encouraged. Patients were evaluated based on clinical and radiographic examinations, shoulder joint range of motion, Constant–Murley score, and subjective shoulder value. Results Four cases in the present study could not give a clear description of the traumatic procedure. The other five patients suffered a second strike on their upper arms when they were hurt, with low mobility and high pain in the shoulder region. Seven cases were simple fractures and two were wedge fractures. According to the AO/OTA classification system, four cases were type 12‐A2, three were type 12‐A3, and two were type 12‐B2. Six patients successfully obtained closed manipulative reduction of the shoulder dislocation in the acute stage. The follow‐up time ranged from 18 to 31 months. No deep wound infections were encountered. All fractures healed uneventfully. The union time ranged from 4 to 6 months. At the final follow‐up, shoulder range‐of‐motion values were found to range from 140° to 170° forward flexion, 30° to 40° extension, 40° to 45° adduction, 150° to 170° abduction, 50° to 60° internal rotation, and 50° to 60° external rotation; no recurrent instability of the shoulder joint occurred; the Constant–Murley score was 89.5 ± 3.7 points (range: 84–94 points); the subjective shoulder value was 89.4% ± 6.3% (range: 75%–95%). Conclusion Shoulder dislocation most likely occurs first with an axial force or a direct posteroanterior force and a subsequent force results in the shaft fracture. For patients with mid‐distal humerus fractures, closed manipulative reduction of the joint is usually effective. After success of closed reduction, surgery for the humeral shaft fracture is advocated to ensure stability and to make patient nursing convenient. In cases with fractures in the proximal third of the humeral shaft, fixation is suggested beforehand to help reduce the shoulder dislocation., To describe a treatment strategy for shoulder dislocation associated with a concomitant ipsilateral humeral shaft fracture.