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BACKGROUND: Methamphetamine use has emerged as a major risk factor for cardiovascular and cerebrovascular disease in young adults. The aim of this study was to investigate a possible association of methamphetamine use with cardioembolic stroke. METHODS AND RESULTS: We performed a retrospective study of patients with acute ischemic stroke admitted at our medical center between 2019 and 2022. All patients were screened for methamphetamine use and cardiomyopathy, defined as left ventricular ejection fraction ≤45%. Among 938 consecutive patients, 46 (4.9%) were identified as using methamphetamine. Compared with the nonmethamphetamine group (n=892), the methamphetamine group was significantly younger (52.8±9.6 versus 69.7±15.2 years; P

Background: Humeral shaft fractures account for 1–3% of all bone fractures. Conservative treatment often leads to complications such as non-union and shoulder stiffness. Surgical fixation with a dynamic compression plate (DCP) has been the gold standard treatment. Intramedullary nailing (IMN) has recently gained popularity due to its minimally invasive approach and reduced risk of radial nerve injury. This study aims to compare the outcomes of IMN and plate fixation for humeral shaft fractures. Methods: This retrospective study included patients with humeral shaft fractures treated with either IMN or DCP fixation at Hamad General Hospital between April 2015 and October 2018. Patient demographics, fracture characteristics, surgical outcomes, and complications were collected. Descriptive statistics were used to summarize patient information, and univariate analysis was conducted to compare both groups. A Cox proportional hazards model, adjusted for age, gender, and polytrauma status was applied to compare time to union between IMN and DCP groups. Results: Sixty five patients (25 IMN, 40 plate fixation) were included. Non-union rates were higher in the DCP group than in the IMN group (13% vs. 4%). Reoperation rates were also higher in the DCP group (20% vs. 4%). Postoperative neuropathy rates were 4% for IMN and 10% for DCP, with neuropathy resolution significantly higher in the IMN group (92% vs. 68%). Shoulder range of motion (ROM) and pain favored the DCP group, with 98% unaffected ROM in the plate group compared to 76% in the IMN group (p = 0.007), and a lower incidence of shoulder pain (28% vs. 98%, p < 0.001). Time to union was comparable between both groups, with an adjusted hazard ratio of 1.08 (95% CI 0.62–1.90; p = 0.776). Conclusion: IMN and plate fixation effectively achieved fracture union; however, plate fixation was associated with better shoulder function, reduced pain, and higher reoperation rates. IMN was linked to a lower risk of nerve injury but compromised shoulder ROM and resulted in more postoperative pain. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous sinus thrombosis is a rare stroke with several clinical manifestations. Several studies have identified prognostic risk factors associated with poor functional outcomes and established predictive models. This systematic review and meta-analysis assessed the overall effect size of all prognostic risk factors. Methods: A systematic review was conducted to explore all prognostic risk factors in studies published from the initial to June 2024 among 5 Databases included PubMed / Medline, Scopus, EBSCOhost, Web of Science, and Cochran Library. The quality of the methodology was analyzed using the Newcastle–Ottawa Scale. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 29. Results: Sixty-four studies involving 18,958 participants with a mean age of 38.46 years and females 63.03% were included in the quantitative meta-analysis. Functional outcomes were primarily measured using the Modified Rankin Scale (mRS), with scores ≥ 2 or ≥ 3 indicating poor outcomes in 35.00% and 60.00% of studies, respectively. For general information, age (InOR = 0.98, 95% CI 0.53–1.43), intracranial hemorrhage (OR = 3.79, 95% CI 2.77–5.20), and ischemic infarction (OR = 3.18, 95% CI 2.40–4.23) were associated with poor functional outcomes. For general and neurological symptoms, headache (OR = 0.22, 95% CI 0.17–0.29), seizure (OR = 2.74, 95% CI 1.76–4.27), focal deficit (OR = 4.72, 95% CI 3.86–5.78), coma (OR = 11.60, 95% CI 6.12–21.98), and consciousness alteration (OR = 7.07, 95% CI 4.15–12.04) were outstanding factors. The blood biomarkers of NLR (log OR = 1.72, 95% CI 0.96–2.47), lymphocytes (Cohen's d = -0.63, 95 CI -0.78—-0.47), and D-dimer (lnOR = 1.34, 95% CI 0.87–1.80) were the three most frequently reported factors. Parenchymal lesion (OR = 4.71, 95% CI 1.12–19.84) and deep cerebral venous thrombosis (OR = 6.30, 95% CI 2.92–13.63) in radiological images were two frequently reported factors. CVST patients with cancer (OR = 3.87, 95% CI 2.95–5.07) or high blood glucose levels (OR = 3.52, 95% CI 1.61–7.68) were associated with poor functional outcomes. In the meta-regression analysis, ischemic infarction (P = 0.032), consciousness alteration (P < 0.001), and NLR (P = 0.015) were associated with mRS prediction. Conclusions: Pooled effect sizes revealed that ischemic infarction, headache, neurological focal deficit, lymphopenia, and cancer were significantly associated with poor functional outcomes, with low to moderate heterogeneity. Consciousness alterations/deterioration and deep cerebral venous thrombosis were also significant prognostic factors, albeit with substantial heterogeneity. The meta-regression analysis showed that the effect sizes of consciousness alterations/deterioration and NLR increased with worsening mRS scores. Other notable risk factors included age, intracranial hemorrhage, seizures, coma, D-dimer, parenchymal lesions, and hyperglycemia. This systematic review provides a comprehensive overview of the prognostic risk factors for poor functional outcomes in patients undergoing CVST, which can guide clinical decision-making and future research. Trial registration: This systematic review and meta-analysis has been registered with INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols), and the registration number is INPLASY202480072. The registration period is 14 August 2024. [ABSTRACT FROM AUTHOR]

Traumatic Brain Injury (TBI) is a devastating cause of death and disability. Outcomes following TBI have been extensively studied; however, less attention has been given to identifying characteristics of individuals who have a favorable outcome following severe TBI. We conducted a retrospective analysis of a database containing information on TBI patients admitted to a level 1 trauma center between 2015 and 2021. We focused on patients who were initially admitted with severe TBI (GCS 8 or lower), and had a final favorable functional outcome (GOSE 5 or higher), at six months. Our investigation aimed to identify factors associated with early in-hospital recovery versus delayed post-discharge recovery, as well as factors associated with moderate disability versus good recovery in six-month follow-up, the time that all investigated patients had achieved a favorable outcome. A total of 513 patients were included in the study. Of these, 67.2% achieved early in-hospital recovery, while 32.8% experienced delayed post-discharge recovery. Features such as anisocoric or fixed pupillary light reflex, subarachnoid hemorrhage, intraventricular hemorrhage and, the need for decompressive craniectomy, and tracheostomy were independently associated with delayed recovery in severe TBI patients. Among the 513 patients, 105 (20.4%) had moderate disability, while 408 (79.6%) were in good recovery at the six-month follow-up. Midline shift greater than 5 mm and the need for tracheostomy were independently associated with moderate disability. Our study offers insights into characteristics of severe TBI patients with a favorable outcome at six months. Our results suggest that it may be premature to predict a poor prognosis for patients with severe TBI who do not show early improvement after their injury. Interestingly, approximately one third of patients with a favorable six-month outcome fell into this category. [ABSTRACT FROM AUTHOR]

Introduction: There has been limited research on predicting the functional prognosis of patients with nonsurgical intracerebral hemorrhage (ICH) from the acute stage. The aim of this study was to develop a risk prediction model for the natural course in patients with nonsurgical ICH and to evaluate its performance using a multicenter hospital-based prospective study of stroke patients in Japan. Methods: We consecutively registered a total of 1,017 patients with acute ICH (mean age, 68 years) who underwent conservative treatment and followed them up for 3 months. The study outcome was a poor functional outcome (modified Rankin Scale score, 4–6) at 3 months after ICH onset. To develop the risk prediction model for natural course in patients with nonsurgical ICH, we included the following clinical common factors assessed on admission in daily clinical practice for ICH: age, sex, medical history (hypertension, diabetes mellitus, dyslipidemia, pre-stroke dementia, previous stroke, coronary artery disease, smoking status, alcohol drinking status, oral anticoagulation, and antiplatelet medication), admission status (time from onset to admission, systolic blood pressure, diastolic blood pressure, pulse pressure, plasma glucose levels, severity of the stroke), and neuroradiologic data (ICH location, intraventricular hemorrhage, and hematoma volume). The risk prediction model for poor functional outcome was developed using logistic regression analysis. In addition, the risk prediction model was translated into a point-based simple risk score (FSR ICH score) using the approach in the Framingham Heart Study. Results: At 3 months after the ICH onset, 323 (31.8%) patients developed a poor functional outcome. Age, diabetes mellitus, pre-stroke dementia, NIHSS score on admission, intraventricular hemorrhage, and hematoma volume were included in the risk prediction model. This model demonstrated excellent discrimination (C statistic = 0.884 [95% confidence interval, 0.863–0.905]; optimism-corrected C statistic based on 200 bootstrap samples = 0.877) and calibration (Hosmer-Lemeshow goodness-of-fit test: p = 0.72). The FSR ICH score, a point-based simple risk score, also showed excellent discrimination, with a C statistic of 0.882 (95% CI: 0.861–0.903). Conclusions: We developed a new risk prediction model for 3-month poor functional outcome in patients with nonsurgical ICH using a multicenter hospital-based prospective study in Japan. The current risk prediction model has the potential to be a useful tool for estimating the natural course in patients with nonsurgical ICH, aiding in making treatment decisions, including surgical options, early formulation of rehabilitation plans, and efficient utilization of medical resources. [ABSTRACT FROM AUTHOR]

Background: The burden of schizophrenia is largely due to deficits it causes in functioning. However, the variables influencing and predicting real-life functioning have not been systematically investigated in such patients. Aims: The aims of this study were to study the sociodemographic data, illness-related variables, and level of functioning in patients with schizophrenia and to assess the relationship between clinical correlates, symptomatology, and level of functioning. Materials and Methods: This was a cross-sectional study conducted in the psychiatry outpatient department of a teaching hospital. Sociodemographic and illness-related data were collected using a semi-structured pro forma. Schizophrenia was diagnosed as per the International Classification of Diseases-10 criteria, and severity of symptoms was rated using Positive and Negative Syndrome Scale (PANSS). Functional outcomes were rated using the Social and Occupational Functioning Assessment Scale (SOFAS) and Specific Level of Functioning (SLOF) scale. The data were compiled, tabulated, and analyzed. Results: A total of 170 patients suffering from schizophrenia with a mean age of 38.22 years were recruited for the study. On the SOFAS, 56.5% of patients scored more than 60, indicating good functionality. It was found that age at onset had a positive correlation, whereas duration of illness, duration of untreated psychosis (DUP), positive family history of psychosis, and PANSS scores had a negative correlation with SOFAS and SLOF subdomain scores. Conclusion: In patients with schizophrenia, male gender, unemployment, positive family history of psychosis, lower age at onset, longer duration of illness, longer DUP, and greater symptom severity (positive and negative) are associated with poor functioning. [ABSTRACT FROM AUTHOR]

Background: Meniscal repair in bucket-handle tears has proven to be effective. However, when such lesions are chronically displaced and adhered to intercondylar soft tissues, their repair may be considered unfeasible. Accordingly, the objective of this study is to show the surgical technique for the reduction and repair of this type of injury and to evaluate the long-term outcomes of such repairs. Materials and Methods: We conducted a retrospective case series of eight patients who were identified between 2006 and 2015 and presented with chronically displaced, medial meniscus bucket-handle tears. The bucket-handle tears were reduced, and the medial meniscus was repaired in all cases. The knee was immobilized in full extension and maintained nonweight bearing for 2 weeks. Then, the range of movement was limited from 0° to 90° and kept partially weight bearing for 4 more weeks. Results: The mean age of the patients was 27.2 years. The mean time to surgery was 7.12 ± 4.4 months, and the mean follow-up time was 10.0 ± 3.4 years. The average preoperative and postoperative Lysholm score was 58.0 ± 16.2 and 95.9 ± 3.4, respectively (P = 0.008). The mean preoperative and postoperative Tegner was 5.5 ± 1.1 and 5.1 ± 1.1, respectively (P = 0.109). The average KT-1000 of the participants was 1.2 ± 1.2, and the mean International Knee Documentation Committee was 92.9 ± 5.0. The average Ählback score at follow-up was 0.83 ± 0.4. Conclusions: The treatment of chronically dislocated bucket-handle tears can be successfully achieved by the sequential release and suture of the torn meniscus. Good outcomes and low rates of osteoarthritis were observed at 10-year follow-up. Level of Evidence: IV [ABSTRACT FROM AUTHOR]

In the acute stage of stroke, stress hyperglycemia is common in both diabetic and nondiabetic patients. The associations between stress hyperglycemia and functional outcomes, as well as stroke recurrence were heterogeneous in previous studies. We aimed to demonstrate these associations in a general population of patients with ischemic stroke and transient ischemic attack (TIA). We included patients with complete data on blood glucose and hemoglobin from The Third China National Stroke Registry. The stress hyperglycemia ratio (SHR) was calculated using fasting blood glucose (mmol/L) divided by glycosylated hemoglobin A1c (%). Outcomes included functional disability, recurrent ischemic stroke and TIA, combined vascular events, and all-cause mortality at 90 days. In total, 7186 patients were included (median age: 62 [54–70] years, male: 4864 [67.69%], TIA: 589 [8.20%]). SHR levels were significantly associated with functional disability (adjusted OR: 1.69, 95%CI: 1.22–2.33). For every 1 standard deviation increment in SHR, the risk of functional disability increased by 13%. Compared to the patients in SHR Tertile 1, those in Tertile 3 had a 1.31-fold increased risk of functional disability (95%CI: 1.08–1.60). There was a trend indicating that the risk of functional disability increased with higher SHR tertiles (P for trend = 0.0074). Stroke severity explained 42.94% of the total excess association between SHR and functional disability. However, neither SHR levels nor SHR tertiles were associated with recurrent ischemic stroke and TIA, combined vascular events, or all-cause mortality. This study found that admission stress hyperglycemia was associated with functional disability, which was partially mediated by stroke severity. [ABSTRACT FROM AUTHOR]

Background: The choice between primary arthrodesis (PA) and open reduction and internal fixation (ORIF) for acute Lisfranc injuries remains contentious. Apart from primary treatment, arthrodesis is often used for treating chronic Lisfranc injuries, including patients in whom initial ORIF or nonoperative treatment failed. The aim of this study was to compare PA and secondary arthrodesis (SA) in terms of complications and functional outcome. Methods: A retrospective cohort study was conducted on trauma patients with Lisfranc injuries treated at a level 1 trauma center between July 1, 2010, and July 1, 2020. Selected patients were evaluated at the outpatient clinic and received a survey. Demographics, injury characteristics, management, complications, and patient-reported outcomes (American Orthopaedic Foot & Ankle Society midfoot score, Foot Function Index) were analyzed. Results: Twenty-nine of 37 potential patients (78.4%; PA n = 11, SA n = 18) completed the survey with a median follow-up of 7.1 (PA) to 9.3 (SA) years (P =.01). The majority were female (n = 18, 62.1%); the mean age of PA patients was 57.1 years (SD 14.2) compared with 43.5 years (SD 17.1) in SA patients (P =.04). In the PA group, there was no infection, 100% union, and implants were removed in 5 of 11 patients. In the SA group, 11.1% (n = 2) developed infection, malunion rate was 11.1%, implants were removed in 33.3% (n = 6), and 22.2% required revision surgery. AOFAS was "good" in PA (77.7, SD 17.3) compared with rated "fair" in SA (67.1, SD 21.3, P =.19). FFI was better in PA (26.0, SD 26.2) than SA (37.6, SD 30.8, P =.32), which exceeded the minimally important clinical difference. Conclusion: Although this study was limited by sample size, the overall results suggest equivalent functional outcome, pain and treatment satisfaction in primary arthrodesis compared with secondary arthrodesis patients for treatment of Lisfranc injury. [ABSTRACT FROM AUTHOR]

In severe periprosthetic joint infection after total knee arthroplasty (TKA), multistage procedures are indicated for ongoing signs of infection after implant removal during the spacer interval of an intended 2-stage exchange. In these cases, several additional debridement and spacer exchange surgeries may be necessary. Herein, we analyzed the complications, remission rates, and functional outcomes after multistage revision arthroplasty using hinged TKAs. Patients (n = 79) treated with multistage revision arthroplasty after chronic periprosthetic joint infection of the knee were included (2010 to 2018). During the prosthesis-free interval, a static spacer containing antibiotic-loaded bone cement was implanted. The mean number of surgeries, including implant removal and revision arthroplasty, was 3.8 (range, 3 to 8). The mean duration from implant removal to revision arthroplasty was 83 days (range, 49 to 318). Complications, remission, and mortality were analyzed after a minimum follow-up of 5 years. Outcomes were assessed based on the Knee Society Score (KSS) and the Western Ontario McMasters University Osteoarthritis Index. During follow-up, 24 (30.4%) patients underwent revision surgery, with a mean time to surgical revision of 99 weeks (range, 1 to 261). After follow-up, the infection-free remission rate and overall mortality were 87.3 and 11.4%, respectively. The mean KSS was 74.3 (range, 24 to 99), the KSS Function Score was 60.8 (range, 5 to 100), and the Western Ontario McMasters University Osteoarthritis Index 30.2 (range, 5 to 83). In difficult-to-treat cases, multistage revision arthroplasty showed high remission rates and low mortality after a follow-up of 5 years. The overall revision rate was comparably high, accounting for early and late reinfections most of the time. In cases of implant survival, functional outcomes comparable to those of revision hinge TKA reported in the literature can be achieved. Therefore, multistage procedures with additional debridement steps should be performed in cases of ongoing infections in intended 2-stage procedures. [ABSTRACT FROM AUTHOR]

Study Design: Systematic review. Objective: This systematic review aims to identify prognostic factors, encompassing biomedical and psychosocial variables, linked to outcome of fusion surgery for chronic low back pain (CLBP) in single or two-level lumbar degenerative spinal disorders. Identifying these factors is crucial for decision making and therefore long-term treatment outcome. Methods: A systematic search (PROSPERO ID: CRD4202018927) from January 2010 to October 2022 was conducted, utilizing Medline, Embase, and the Cochrane Database of Systematic Reviews (CDSR, CENTRAL). Prognostic factors associated with various outcomes, including functional status, back and leg pain, health-related quality of life, complications, return to work, and analgesic use, were assessed. Risk of bias was determined using QUIPS, and the quality of evidence was evaluated using GRADE approach. Results: Of the 9852 initially screened studies, eleven studies (n = 16,482) were included in the analysis. In total, 161 associations were identified, with 67 prognostic factors showing statistical significance (P < 0.05). Thirty associations were supported by two or more studies, and only eight associations were eligible for meta-analyses: female gender remained statistically significant associated with decreased postoperative back pain, but negatively associated with complication rates and functional status, and smoking with increased postoperative back pain. Conclusion: Only female gender and smoking were consistently associated with outcome of fusion for CLBP. Most of the included studies exhibited low to moderate methodological quality, which may explain the relatively weak associations identified for the assessed prognostic factors. [ABSTRACT FROM AUTHOR]

Growth-differentiation factor 15 (GDF-15) is a cytokine involved in cellular stress responses and inflammation. This meta-analysis evaluates the association between circulating GDF-15 levels and functional outcomes in patients with acute ischemic stroke (AIS). A comprehensive search of Medline, Web of Science, Embase, Wanfang, and CNKI was conducted up to July 15, 2024. Observational studies with longitudinal follow-up that measured GDF-15 levels within 24 h of stroke onset and reported functional outcomes, defined as a modified Rankin Scale (mRS) score of ≥ 2, were included. Odds ratios (OR) with 95% confidence intervals (CI) were used to quantify associations. Heterogeneity was evaluated using I² statistics, and a random-effects model was used to pool the results by incorporating the influence of heterogeneity. Ten studies involving 4,231 patients were included. The pooled OR indicated that high circulating GDF-15 levels were associated with a significantly higher risk of poor functional outcomes at 3 months (OR: 2.60, 95% CI: 1.95 to 3.46, p < 0.001). Sensitivity analyses by excluding one study at a time did not significantly change the results. Subgroup analyses revealed stronger associations in studies with GDF-15 cutoff values < 1200 ng/L as compared to ≥ 1200 ng/L, and in those defining poor outcomes as mRS ≥ 3 as compared to those ≥ 2. In conclusion, elevated circulating GDF-15 levels are associated with worse functional outcomes following AIS. These findings support the potential use of GDF-15 as a prognostic biomarker in stroke patients. Further research is warranted to confirm these results and explore clinical applications. [ABSTRACT FROM AUTHOR]

Introduction: Ankle fractures are the most common type of fractures treated by orthopaedic surgeons. Malleolar fractures are one of the most common fractures in orthopaedic traumatology. As with all intra-articular fractures, malleolar fractures necessitate accurate reduction and stable internal fixation. As for the treatment of malleolar fractures, the stable ones are reduced by conservative treatment. The other unstable, displaced and open fractures require Open Reduction and Internal Fixation (ORIF). The superiority of ORIF over closed treatment has been thoroughly demonstrated in literature. The purpose of this study is to assess the functional outcome and results of surgical treatment of bimalleolar fractures. Materials and methods:This study is conducted in GVPIHC&MT, Visakhapatnam. Patients presenting to the casualty and admitted with bi-malleolar fractures were selected. This is a prospective observational study. The duration of study period is one year 6 months of regular study from Jan 2023 to Jun 2024 including 6 months of follow up after surgery. A total of 40 cases satisfying the following the inclusion and exclusion criteria alone were included in the study. Results: We worked with 40 adult patients. The overall score secured under the O-M system was used to categorise patients into four groups as having the functional outcome 'excellent', 'good', 'fair' and 'poor'. It was seen that the patients falling in the four categories constituted 22.5%, 55%, 17.5% and 5% respectively. Minor complications arose in 5 cases and they were treated with medication. It was further found that, with increase in age, the time taken for union also increased. It was also evident that sex of the patient had no bearing on the functional outcome of surgery. Conclusion: The study lends support to the hypothesis that Open Reduction and Internal Fixation yields excellent to good results in restoring the normal anatomy of the joint. This conclusion assumes importance because every single patientis unique. [ABSTRACT FROM AUTHOR]

Stroke causes severe long‐term disabilities with a significant reduction in quality of life. This study aims to explore the predictive value of cognitive screening in the acute phase of mild stroke on patients' functional outcome after discharge. A total of 110 patients with mild stroke were recruited. Patients were included in the study if they were discharged directly home from the acute units. The cognitive profile of patients was assessed with the Oxford Cognitive Screen (OCS). The OCS was administered 3–10 days after stroke, providing a five domain‐specific cognitive profile. Long‐term functional outcomes were evaluated by the Stroke Impact Scale 3.0 (SIS 3.0), a self‐reported questionnaire that includes physical, cognitive, emotional and social participation dimensions. All patients completed the survey online on average 10 months after stroke. Our results show that OCS is positively associated with physical and cognitive dimensions, after adjusting for age and stroke severity measured by NIHSS at admission. In conclusion, OCS in acute mild stroke seems to be an independent predictor of long‐term functional outcomes and could help clinicians in the long‐term management of patients. [ABSTRACT FROM AUTHOR]

Background: Whether minimally invasive endoscopic surgery (ES) improves survival and functional outcome in people with spontaneous supratentorial intracerebral hemorrhage (SSICH) is unknown. Methods: This is a single-center pilot study performed between July 2021 to January 2023. Any supratentorial hematoma with a volume between 20 mL and 100 mL was endoscopically evacuated within 24 h after bleeding onset. Participants were followed-up for 6 months, assessing clinical and radiological outcomes. The primary feasibility outcome was satisfactory hematoma removal (<15 mL residual volume on the first postinterventional CT study) and the primary efficacy outcome was reaching a modified Rankin Scale 0–3 (mRS) at 6 months. Secondary outcomes were mortality and morbidity rates. Results: Ten participants (median age 72.5 years [IQR 67–81], 70% male, median baseline hematoma volume 34.1 [IQR 25.5–58.0]) were included. Satisfactory hematoma evacuation was achieved in 70% (7/10) with a median evacuation percentage of 69.5% [IQR 45.3–93.9%]. The median duration of surgery was 91 min [IQR 73–111]. Favorable outcome at 6 months was observed in 60% of the participants and improved from within 24 h before the intervention to the last follow-up (6 months). Five participants (50%) experienced a total of six complications, two recurrent bleedings, three pneumonias and one epilepsy. Mortality rate was 30%, while one participant died from pneumonia, one from a recurrent bleeding, and one participant due to a glioblastoma. Conclusion: ES appears to be feasible, with satisfactory hematoma removal being achieved in the majority of participants. Based on the descriptive results of this pilot trial, a national multicenter RCT comparing ES to best medical treatment is currently ongoing Clinical trial registration: https://clinicaltrials.gov/, identifier NCT05681988. [ABSTRACT FROM AUTHOR]

Background: Accurate prediction of neurorehabilitation outcomes following Spinal Cord Injury (SCI) is crucial for optimizing healthcare resource allocation and improving rehabilitation strategies. Artificial Neural Networks (ANNs) may identify complex prognostic factors in patients with SCI. However, the influence of psychological variables on rehabilitation outcomes remains underexplored despite their potential impact on recovery success. Methods: A cohort of 303 patients with SCI was analyzed with an ANN model that employed 17 input variables, structured into two hidden layers and a single output node. Clinical and psychological data were integrated to predict functional outcomes, which were measured by the Spinal Cord Independence Measure (SCIM) at discharge. Paired Wilcoxon tests were used to evaluate pre–post differences and linear regression was used to assess correlations, with Pearson's coefficient and the Root Mean Square Error calculated. Results: Significant improvements in SCIM scores were observed (21.8 ± 15.8 at admission vs. 57.4 ± 22.5 at discharge, p < 0.001). The model assigned the highest predictive weight to SCIM at admission (10.3%), while psychological factors accounted for 36.3%, increasing to 40.9% in traumatic SCI cases. Anxiety and depression were the most influential psychological predictors. The correlation between the predicted and actual SCIM scores was R = 0.794 for the entire sample and R = 0.940 for traumatic cases. Conclusions: The ANN model demonstrated the strong impact, especially for traumatic SCI, of psychological factors on functional outcomes. Anxiety and depression emerged as dominant negative predictors. Conversely, self-esteem and emotional regulation functioned as protective factors increasing functional outcomes. These findings support the integration of psychological assessments into predictive models to enhance accuracy in SCI rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

Background and purpose: Elevated serum lipoprotein(a) (Lp[a]) levels have been linked to an increased incidence of stroke. This systematic review and meta‐analysis aimed to evaluate the impact of serum Lp(a) on the functional outcomes of patients with ischemic stroke (IS). Methods: We conducted a comprehensive search of the MEDLINE, Web of Science, Embase, Wanfang, and China National Knowledge Infrastructure databases to identify relevant cohort studies. A random effects model was utilized to synthesize the data, accounting for study heterogeneity. Results: The analysis included 11 cohort studies comprising 11,958 patients with IS. Pooled results indicated that high baseline Lp(a) levels were associated with an increased risk of poor functional outcomes during follow‐up (odds ratio [OR] = 2.13, 95% confidence interval = 1.67–2.71, p < 0.001, I2 = 62%). Subgroup analyses revealed that the relationship between high Lp(a) levels and the risk of poor functional outcomes was more pronounced at discharge (OR = 3.25), 3 months (OR = 2.02), and 6 months (OR = 2.11) poststroke, compared to 12 months (OR = 1.25, p for subgroup difference < 0.001). Furthermore, the association was attenuated yet remained significant in studies adjusting for low‐density lipoprotein cholesterol (LDL‐C) compared to those that did not adjust for LDL‐C (OR = 1.69 vs. 2.63, p for subgroup difference = 0.03). Conclusions: High serum Lp(a) levels at baseline are significantly associated with poor functional outcomes in patients with IS. [ABSTRACT FROM AUTHOR]

Hamstring injuries are a frequent occurrence of athletes, leading to a stop in practice and long-term alterations in sports performance. About 12% of these lesions involve avulsion at the level of the proximal insertion that can be complete (about 6%) or partial. Starting from an epidemiological and treatment evaluation of these lesions in literature, the aim of this study was to examine the functional outcomes and the rate of "return to play" in a population composed of athletes of various levels who have undergone surgery to reinsert the hamstring muscles at the ischial insertion, for a complete detachment of one or more tendon heads. Therefore, a retrospective study was carried out where 18 patients treated at the Orthopedics and Traumatology Unit of the I.R.C.C.S. San Matteo in Pavia (Italy) were identified in a time span ranging from March 2012 to August 2020. The sample was analysed taking into account age, sex and risk factors, as well as the pathophysiology and anatomy of the injury using the Wood classification, the time elapsed before surgery, the duration of the rehabilitation protocol and the possible return to sports activity, comparing the level of sports performance in the pre- and post-operative period using the Tegner Activity Score (TAS). Different post-operative outcome evaluation scores (Perth Hamstring Assessment Tool PHAT and Lower Extremity Functional Scale LEFS) were also compared with each other in order to find a correlation with the real level of return to sporting activity. The mean age at surgery was 26.4 11.6 years. The population is composed of 14 males (77.8%) and 4 females (22.2%). All 18 patients returned to sports following surgery (100%). Of these patients, 17 (94%) maintained a level of sports performance equal to that before the injury. 100% of patients rated the outcome of the surgery as satisfactory. This study has shown that Hamstring reinsertion surgery is a correct indication in all athletes, allowing them a satisfactory return to sports practice. [ABSTRACT FROM AUTHOR]

Background: Temperature abnormalities are common after spontaneous subarachnoid hemorrhage (SAH). Here, we aimed to describe the evolution of temperature burden despite temperature control and to assess its impact on outcome parameters. Methods: This retrospective observational study of prospectively collected data included 375 consecutive patients with SAH admitted to the neurological intensive care unit between 2010 and 2022. Daily fever (defined as the area over the curve above 37.9 °C multiplied by hours with fever) and spontaneous hypothermia burden (< 36.0 °C) were calculated over the study period of 16 days. Generalized estimating equations were used to calculate risk factors for increased temperature burdens and the impact of temperature burden on outcome parameters after correction for predefined variables. Results: Patients had a median age of 58 years (interquartile range 49–68) and presented with a median Hunt & Hess score of 3 (interquartile range 2–5) on admission. Fever (temperature > 37.9 °C) was diagnosed in 283 of 375 (76%) patients during 14% of the monitored time. The average daily fever burden peaked between days 5 and 10 after admission. Higher Hunt & Hess score (p = 0.014), older age (p = 0.033), and pneumonia (p = 0.022) were independent factors associated with delayed fever burden between days 5 and 10. Increased fever burden was independently associated with poor 3-month functional outcome (modified Rankin Scale 3–6, p = 0.027), poor 12-month functional outcome (p = 0.020), and in-hospital mortality (p = 0.045), but not with the development of delayed cerebral ischemia (p = 0.660) or intensive care unit length of stay (p = 0.573). Spontaneous hypothermia was evident in the first three days in patients with a higher Hunt & Hess score (p < 0.001) and intraventricular hemorrhage (p = 0.047). Spontaneous hypothermia burden was not associated with poor 3-month outcome (p = 0.271). Conclusions: Early hypothermia was followed by fever after SAH. Increased fever time burden was associated with poor functional outcome after SAH and could be considered for neuroprognostication. [ABSTRACT FROM AUTHOR]

Winter birth has consistently been identified as a risk factor for schizophrenia. This study aimed to determine whether individuals born during this season are also at higher risk for early psychosis and whether this is associated with distinct functional and clinical outcomes. We conducted a prospective study on 222 patients during their early phase of psychosis in Switzerland, nested in the Treatment and Early Intervention in Psychosis (TIPP) cohort. We compared the birth trimesters of these patients with those of the general Swiss population. Additionally, we evaluated the Global Assessment of Functioning scale (GAF) and the Positive and Negative Syndrome Scale (PANSS) scores among patients born in winter (January to March) versus those born during the rest of the year during a three-year follow-up period. A significantly higher proportion of patients experiencing early psychosis were born in winter compared to the general Swiss population. Patients born in winter had significantly lower GAF scores at 6 months, 24 months, and 36 months of follow-up, compared to patients born during the rest of the year. They also manifested fewer positive symptoms, as indicated by the PANSS positive subscale. Birth in winter appears to be associated with a lower functional outcome and potentially distinct symptomatology in the early phase of psychosis. [ABSTRACT FROM AUTHOR]

Background and Aims: In hip surgeries, the pericapsular nerve group (PENG) block and supra-inguinal fascia iliaca (SIFI) block are commonly employed perioperative regional analgesia techniques. This study aimed to compare functional outcomes regarding quadriceps muscle strength and weight-bearing capacity between PENG and SIFI blocks after hip surgery. Methods: In this single-centre, double-blinded, randomised trial, 60 patients undergoing hip surgeries under subarachnoid block were randomised into either Group P (PENG block) or Group S (SIFI block). Blocks were administered under ultrasound guidance with 30 mL of 0.2% ropivacaine and 4 mg dexamethasone. Functional mobility was assessed 24 and 48 h postoperatively by measuring quadriceps strength and maximum weight-bearing capacity. Analgesic efficacy was also evaluated by comparing visual analogue score (VAS) scores at 24 h, total opioid consumption over 24 h, and duration of analgesia. Statistical analysis included Student's t -test, Chi-square, and Z-test as appropriate, with statistical significance set at P < 0.05. Results: Group P demonstrated significantly higher quadriceps-muscle strength at 24 h (P = 0.025) and 48 h (P = 0.002) post surgery. More patients in Group P achieved superior weight-bearing grades at 24 h (P = 0.002) post surgery compared to Group S. VAS scores were significantly lower in Group P at 24 h post surgery (P = 0.006). Group P also showed a prolonged duration of analgesia (P = 0.019) and lower mean opioid consumption (P = 0.001) compared to Group S. Conclusion: The PENG block may be superior to the SIFI block in terms of functional outcomes with better quadriceps strength, enhanced weight-bearing, and provision of more effective postoperative analgesia in hip surgery patients. [ABSTRACT FROM AUTHOR]

Little is known about the resumption of sporting activities following megaprosthetic reconstruction of the distal femur and proximal tibia after resection of a bone sarcoma. Thus, the aims of our study were: (1) to assess the functional outcome; (2) to evaluate pre- and post-operatively performed sporting activities; and (3) to identify potential beneficial and limiting factors. Between 1993 and 2015, a total of 230 patients underwent distal femoral replacement (DFR), and 96 patients underwent proximal tibial replacement (PTR). The exclusion criteria were death, amputation, living overseas, and a congenital disability. Functional outcome and sporting activities were assessed using the Musculoskeletal Tumor Society Score (MSTS), Toronto Extremity Salvage Score (TESS), Forgotten Joint Score (FJS), subjective knee value (SKV), the Tegner activity score (TS), and the modified weighted activity score (WAS). There were 93 patients who had a median follow-up of 182 months (interquartile range (IQR) 130 to 260) after DFR with the following median scores: MSTS 18 (IQR 12 to 23), TESS 75% (IQR 60 to 84), FJS 25 (IQR 8 to 40), SKV 53% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 0 to 8). There were 42 patients who had a median follow-up of 193 months (IQR 137 to 244) after PTR had the following median scores: MSTS 17 (IQR 15 to 22), TESS 78% (IQR 68 to 88), FJS 32 (IQR 20 to 46), SKV 60% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 1 to 10). Postoperatively, 61% of DFR and 76% of PTR patients participated in at least one sporting activity. The functional outcome is overall good with a regular resumption of sporting activities. Patients' age at surgery and higher preoperative sporting levels were associated with better functional outcomes and higher postoperative sporting activity. [ABSTRACT FROM AUTHOR]

Purpose: The systemic inflammation response index (SIRI) has recently emerged as a novel inflammatory and prognostic marker across various diseases. However, there is limited research examining the relationship between SIRI and 90-day functional outcome in patients with acute large vessel occlusion stroke (ALVOS) undergoing mechanical thrombectomy (MT). This study aimed to investigate the potential of SIRI as an innovative, inflammation-based predictor of 90-day functional outcome. Methods: This retrospective cohort study consecutively recruited 604 Chinese patients with diagnosed ALVOS who underwent MT at the First College of Clinical Medical Science of China Three Gorges University between July 2017 and April 2023. Comprehensive data, including baseline demographic and clinical characteristics, were systematically extracted from electronic medical records. Poor functional outcome at 90 days was defined as modified Rankin Scale (mRS) score ≥ 3. We employed logistic regression models, curve fitting, sensitivity analyses, subgroup analyses, and receiver operating characteristic (ROC) curves to validate the association between SIRI and poor outcome, as well as to assess the predictive efficacy. Results: Final analysis included 604 ALVOS subjects of whom 54.3% experienced poor functional outcome at 90 days. In the multivariate analysis, after adjusting for potential confounders, SIRI remained significantly associated with an elevated risk of poor outcomes (OR 1.18, 95% CI 1.08– 1.28, P < 0.001). Nonlinear curve fitting revealed a reverse J-shaped association between SIRI and poor outcomes, with inflection points at 4.5. Subgroup analyses showed no significant interactions (all P for interaction > 0.05), However, atrial fibrillation demonstrated a significant interaction (all P for interaction = 0.001). Conclusion: SIRI shows promise as a novel prognostic marker for 90-day functional outcome in patients with ALVOS undergoing MT. The identified nonlinear relationship and inflection point may provide valuable insights for risk stratification and clinical decision-making in this specific patient population. [ABSTRACT FROM AUTHOR]

Background & Aims: Rotational malalignment after intramedullary nailing of intertrochanteric fractures is a relatively common complication that may have a crucial impact on both functional outcome and a fracture's healing properties, ultimately affecting the patient's postoperative morbidity and mortality. Methods: 74 patients treated with intramedullary nailing due to an intertrochanteric fracture underwent a postoperative computed tomography (CT) scan of the hips and knees. The femoral anteversion difference (D angle) between the operated and healthy hip was calculated using the technique described by Jeanmart's method. The patients were divided into two groups according to their D angle values: a D angle less than 15° was considered an acceptable rotational alignment (group A), while a D angle equal to or more than 15° was considered a rotational deformity (group B). Postoperatively, the functional level of each patient was evaluated at the 6-month and 1-year follow-up visits and compared to the pre-fracture status using the modified Harris hip score (mHHS). Also, fracture union, other postoperative complications, and patient mortality were noted. Results: The mean femoral anteversion difference was 12.3° with a standard deviation of 10.3°. Of the 74 patients, 51 (68.9%) were assigned to group A and 23 (31.1%) to group B. At the 6-month postoperative follow-up, 67 (90.5%) patients had survived and 7 (9.5%) were deceased, with our statistical analysis indicating a linear trend (p-value = 0.048) between the presence of rotational malalignment and 6-month mortality. At the 1-year postoperative follow-up, 63 (85.1%) patients survived and 11 (14.9%) were deceased, with the statistical analysis indicating a significant relationship (p-value = 0.031) between the presence of rotational malalignment and the 1-year mortality. Regarding the functional outcome six months after the operation, the difference between the pre-fracture and the postoperative mHHS was 8.7/100 with a standard deviation of 6.1 for the 49 patients in group A and 14.5/100 with a standard deviation of 12.4 for the 18 patients in group B, with the statistical analysis indicating a significant difference (t = −2.536, significance < 0.05) in the functional level between the two groups. As for the functional outcome one year after the operation, the difference between the pre-fracture and the postoperative mHHS was 4.9/100 with a standard deviation of 7.8 for the 47 patients in group A and 8.3/100 with a standard deviation of 13 for the 16 patients in group B, with the statistical analysis indicating no significant difference (t = −1.266, significance > 0.05) in the functional level between the two groups. The only postoperative complication noted was fracture non-union, presenting in two patients (3%), with the statistical analysis indicating no significant relationship (p-value = 0.698) between this complication and the presence of rotational malalignment. Conclusions: In this study, rotational malalignment after intertrochanteric fracture intramedullary nailing presents in 31.1% of cases. The correlation between this malalignment and functional outcomes shows a decline in patients' functional abilities during the first six postoperative months, a condition that improves over time, with most patients returning to their preoperative functional status one year after the operation. Furthermore, our results indicate a possible relationship between rotational malalignment and mortality within one year. Future research should focus on creating a more detailed, functional evaluation system for the elderly and applying it to a larger sample to confirm these findings. [ABSTRACT FROM AUTHOR]

Aims: Periacetabular osteotomy (PAO) is well established for acetabular reorientation and has shown successful improvement in patient-reported outcome measures (PROMs). Nevertheless, studies focusing on postoperative outcomes related to patient individual factors are still underrepresented. Therefore, this study aimed to analyze the functional outcome and activity level in relation to patient sex with a minimum follow-up of two years after PAO for mild to severe hip dysplasia. Methods: A single-centre study was conducted, enrolling patients undergoing PAO and completing a preoperative and postoperative radiological and clinical outcome assessment. The PROMs were assessed using the modified Harris Hip Score (mHHS), the Hip disability and Osteoarthritis Outcome Score (HOOS) with the subscales for pain, sport, activities of daily living (ADL), and quality of life (QoL), and the University of California, Los Angeles (UCLA) activity score. Kendall’s tau were calculated for correlation analyses. Results: In total, 145 patients (28 male, 117 female) were included. The PROMs improved significantly across males and females at the latest follow-up. Female patients had significantly lower preoperative PROMs: mHHS (47 vs 57.4; p = 0.002); HOOS pain (44.9 vs 60; p = 0.003), sport (47 vs 57.4; p = 0.002), ADL (58.9 vs 69.3; p = 0.032), and QoL (26.8 vs 39.3; p = 0.009); and UCLA (5.6 vs 6.7, p = 0.042) scores. Males showed higher postoperative UCLA scores (7.5 vs 6.7; p = 0.03). Kendall’s tau showed significant negative correlation between BMI and UCLA scores in females and males (-0.21 to -0.29; p = 0.002/0.048), while BMI and HOOS sport (-0.16; p = 0.015) and ADL (-0.2; p = 0.003), as well as QoL (-0.14; p = 0.031) and preoperative acetabular inclination (-0.13; p = 0.049) were only significantly negatively correlated in females. Conclusion: Patient sex affects PROMs before and after PAO. Female patients experience higher improvement in hip function and activity level, due to poorer preoperative PROMs than males. Thus, these data are particularly interesting in providing preoperative guidance regarding postoperative outcome expectations. Cite this article: Bone Jt Open 2024;6(1):35–42.

Background: Unstable trochanteric fractures include posteromedial comminution, reverse oblique pattern, lateral wall fracture and subtrochanteric extension. Unstable trochanteric fractures usually can be treated by anatomical reduction with the use of a sliding hip screw or cephalomedullary nail. DHS is cost-effective and user-friendly whereas PFN, though biomechanically superior, is a relatively new entrant. Thus this comparative study helped us to understand the management of unstable trochanteric fractures in terms of surgical technique and evaluate the functional outcomes after fixation with PFN and DHS. Aims and Objectives: To compare the functional outcome, safety and effectiveness of dynamic hip screw plate (DHS) and proximal femoral nail (PFN) fixation in the management of unstable trochanteric fractures of femur. Materials and Methods: The study was an observational longitudinal follow up comparative study. 50 adult patients of age group 40 to 80 years having unstable trochanteric fractures of femur treated with either DHS plate or PFN were included in the study. 27 such patients were operated with DHS whereas 23 patients were operated with PFN. Modified Harris hip score, duration of hospitalisation, presence or absence of abduction lurch, intraoperative blood loss and procedure time and time to independent mobility were compared between the two groups during postoperative follow up. Results: Patients treated with PFN had better outcome than DHS in terms of shorter duration of hospitalisation, early mobilization in terms of early pain-free full weight bearing, lesser intraoperative blood loss, shorter procedure time and better functional result on the basis of modified Harris hip score at final follow up. But, PFN fixation was associated with more abduction lurch compared to DHS. Conclusion: Thus, PFN proved to be a better implant than DHS in the management of unstable trochanteric fractures of femur.

Introduction. Unicompartmental knee arthroplasty (UKA) is a treatment reserved for single-component osteoarthritis. There are two types of UKA prosthesis: mobile bearing (MB) with a moving implant between the femoral and tibial component, and fixed bearing (FB) with a stable one. It is still under debate what kind of UKA is better, with some studies suggesting no difference between MB and FB. Aim of the study. This study aimed to assess and compare the alignment of unicompartmental knee arthroplasties (UKA) and its impact on functional outcome. Material and methods. Sixty-nine adult patients referred for UKA with a set of X-ray pictures were included in this retrospective study. 28 patients were treated with FB and 41 with MB. Two independent researchers evaluated short radiographs for the alignment of both prosthesis components in anterior-posterior and lateral projections. The functional outcome of arthroplasty was assessed by Knee Osteoarthritis and Outcome Score (KOOS) and International Knee Documentation Committee Subjective Knee evaluation form (IKDC) in 41 patients.Results. The femoral component in MB was placed 4 more varus than in FB. On the lateral view, the difference between placements was 5 for MB placed in flexion and FB placed in extension. There were no significant differences in tibial component alignment. The Spearman correlation test showed a moderately strong negative correlation (R = –0.55) between KOOS Q and femur varus/valgus parameters in the MB group with p = 0.03.Conclusions. More varus femoral component placement in the MB group resulted in better functional outcomes. Other components in both FB and MB did not reveal any correlation with functional outcomes.

Background: Fractures of the distal end of the radius are among the most common skeletal injuries with diverse treatment options. There is no clear consensus regarding the functional outcomes of the diverse treatment options. Aims and Objectives: The aim of the study was to evaluate functional outcomes in distal radius fractures treated with closed reduction and K-wire fixation. Materials and Methods: Fifty-seven patients (26 males and 31 females) with different types of distal radial fractures were treated. Closed reduction and K-wire fixation were performed under axillary block or general anesthesia. Functional outcomes were evaluated using the Mayo Wrist Scoring System. Results: According to the Mayo score, 50.9% (n=29) of our patients had good outcomes, 36.8% (n=21) had fair outcomes, and 12.3% (n=7) had satisfactory outcomes. Conclusions: Closed reduction and Kirschner wire fixation are inexpensive procedures that provide anatomical reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.

Summary: Background & Aims: Sarcopenia and myosteatosis are proving to be major factors to predict mortality in intensive care patients. Few studies are currently focusing on evaluating the functional impact after intensive care discharge and none has considered sarcopenia and myosteatosis as prognostic factors.The aim of our study was to determine whether sarcopenia and myosteatosis are reliable prognostic factors for mid-term functional impact in critical patients a few months after intensive care discharge. Methods: We carried out a retrospective monocentric study using computed-tomography scanner performed on intensive care admission and/or three months after discharge to assess sarcopenia and myosteatosis in 43 patients with critical illnesses who underwent a multidisciplinary evaluation on a multidisciplinary consultation's day hospital.We used L3 and/or T4 computed-tomography-scan levels to assess sarcopenia with the skeletal muscle index and myosteatosis with skeletal muscle density. These data were compared with main patient characteristics on intensive care admission and during intensive care stay and with functional assessments at the post intensive care multidisciplinary consultations, based on hand grip strength test, 6-minute walking test, and peak inspiratory pressure. Results: We found a good correlation of both skeletal muscle index and skeletal muscle density for T4 and L3 levels. Skeletal muscle index was correlated with hand grip strength test, and skeletal muscle density with 6-minute walking test, which are both functional tests recommended in the algorithm of the European Working Group on Sarcopenia in Older People to diagnose sarcopenia. Peak inspiratory pressure was correlated with both skeletal muscle index and skeletal muscle density and also with other functional tests. Conclusions: We confirmed the reliability of thoracic computed-tomography-scan to assess sarcopenia and myosteatosis. We found that skeletal muscle index and skeletal muscle density are independent but complementary predictive factors for functional impact at mid-term in intensive care patients. Peak inspiratory pressure could be a useful tool for the assessment and management of sarcopenia.