The document presents a meta-analysis that compares the outcomes of external fixation (ExFix) versus open reduction and internal fixation (ORIF) for tibial pilon fractures based on 11 observational studies. The analysis found that ORIF had a lower risk of superficial infection, malunion and nonunion compared to ExFix, but a higher risk of unplanned hardware removal. No significant differences were found between the two methods in terms of deep infection, reduction quality, clinical evaluation scores, post-traumatic arthrosis development, or time to union. Overall, the analysis suggests ORIF may have better outcomes for certain complications, while ExFix resulted in fewer subsequent hardware removals.
This systematic review analyzed 49 studies including over 2,300 patients undergoing single-incision laparoscopic cholecystectomy (SILC) or standard laparoscopic cholecystectomy (SLC). The review found that complication rates for SILC ranged from 0-28.6% with an overall median of 7.37%, which may be underestimated due to lack of follow-up in many studies. Studies reported similar or worse pain outcomes for SILC compared to SLC in most cases. Three studies found significantly improved cosmetic outcomes with SILC while others found no significant difference. No definitive evidence suggests that SILC provides improved cosmesis or reduced pain over SLC, and complications may
Objective: To evaluate the clinical effectiveness of Zero-Profile spacer versus traditional cage and plate in anterior cervical
discectomy and fusion.
Methods: An electronic search was conducted in the databases of PubMed, the Cochrane Library, Embase, Web of Science,
Science Direct, Chinese Science and Technology Periodical Database, the China National Knowledge Infrastructure, and Wanfang. A meta-analysis was performed using review manager 5.3.
This meta-analysis compared onlay and sublay mesh repair techniques for open ventral incisional hernias using data from 7 randomized controlled trials involving 954 patients. The analysis found that sublay mesh repair resulted in significantly fewer wound infections and seromas compared to onlay repair, but no significant difference in hematomas. Regarding hernia recurrence, there was no statistical difference between the techniques, but heterogeneity was high and meta-regression showed sublay repair was superior in reducing recurrence. Overall, the meta-analysis indicates sublay mesh repair provides better outcomes than onlay repair for open ventral incisional hernias.
- The study found that patients in ICU rooms with copper alloy surfaces had a significantly lower rate of healthcare-associated infections (HAIs) and methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization compared to patients in standard ICU rooms. Specifically, the HAI and colonization rate was 0.071 in copper rooms vs 0.123 in standard rooms.
- For HAIs only, the rate was reduced from 0.081 in standard rooms to 0.034 in copper rooms. There was no significant difference in length of stay or mortality between the room types.
- The study suggests that copper alloy surfaces may help reduce the risk
Clinical and epidemiological profile of patients undergoing total hip arthro...David Sadigursky
Clinical and epidemiological profile of patients undergoing total hip arthroplasty.
Rheumatology and Orthopedic Medicine
Rheumatol Orthop Med, 2017 doi: 10.15761/ROM.1000120
This literature review evaluated the effects of articulated foot orthotics (AFOs) compared to sensorimotor orthotics (SMOs) on children with cerebral palsy. 8 studies met the inclusion criteria. 6 out of 8 studies found a significant increase in stride length with orthotic use, regardless of duration. Results on gross motor skills effects were mixed, with 2 studies finding improvement and 1 finding no differences. No studies specifically examined the effects of SMOs. Overall, orthotics had generally positive effects on gait outcomes, but the literature lacks studies on SMOs and their effects.
This meta-analysis examined the influence of smoking on dental implant failure. The authors analyzed 19 relevant studies comprising over 10,000 implants. They found that smokers had over twice the odds of implant failure compared to non-smokers. Specifically, implants in the maxillary arch of smokers had over twice the odds of failure, while implants in the mandibular arch did not show a significant increased risk from smoking. This study revealed a significant relationship between smoking and risk of dental implant failure, particularly for implants located in the maxillary arch.
Cutting diathermy and ordinary scalpel for skin incision in open surgery whic...ahmadalmraezy
Cutting diathermy versus scalpel for skin incisions in open surgery: A systematic review and meta-analysis of 41 studies including 6422 patients found that compared to scalpel, diathermy resulted in significantly less blood loss, shorter incision and operative times, and lower postoperative pain scores, while risks of wound complications and hospital stay were comparable between the two techniques. Diathermy was associated with higher rates of seroma formation but no differences in other complications like infection, hematoma, or hernia.
This systematic review analyzed 49 studies including over 2,300 patients undergoing single-incision laparoscopic cholecystectomy (SILC) or standard laparoscopic cholecystectomy (SLC). The review found that complication rates for SILC ranged from 0-28.6% with an overall median of 7.37%, which may be underestimated due to lack of follow-up in many studies. Studies reported similar or worse pain outcomes for SILC compared to SLC in most cases. Three studies found significantly improved cosmetic outcomes with SILC while others found no significant difference. No definitive evidence suggests that SILC provides improved cosmesis or reduced pain over SLC, and complications may
Objective: To evaluate the clinical effectiveness of Zero-Profile spacer versus traditional cage and plate in anterior cervical
discectomy and fusion.
Methods: An electronic search was conducted in the databases of PubMed, the Cochrane Library, Embase, Web of Science,
Science Direct, Chinese Science and Technology Periodical Database, the China National Knowledge Infrastructure, and Wanfang. A meta-analysis was performed using review manager 5.3.
This meta-analysis compared onlay and sublay mesh repair techniques for open ventral incisional hernias using data from 7 randomized controlled trials involving 954 patients. The analysis found that sublay mesh repair resulted in significantly fewer wound infections and seromas compared to onlay repair, but no significant difference in hematomas. Regarding hernia recurrence, there was no statistical difference between the techniques, but heterogeneity was high and meta-regression showed sublay repair was superior in reducing recurrence. Overall, the meta-analysis indicates sublay mesh repair provides better outcomes than onlay repair for open ventral incisional hernias.
- The study found that patients in ICU rooms with copper alloy surfaces had a significantly lower rate of healthcare-associated infections (HAIs) and methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization compared to patients in standard ICU rooms. Specifically, the HAI and colonization rate was 0.071 in copper rooms vs 0.123 in standard rooms.
- For HAIs only, the rate was reduced from 0.081 in standard rooms to 0.034 in copper rooms. There was no significant difference in length of stay or mortality between the room types.
- The study suggests that copper alloy surfaces may help reduce the risk
Clinical and epidemiological profile of patients undergoing total hip arthro...David Sadigursky
Clinical and epidemiological profile of patients undergoing total hip arthroplasty.
Rheumatology and Orthopedic Medicine
Rheumatol Orthop Med, 2017 doi: 10.15761/ROM.1000120
This literature review evaluated the effects of articulated foot orthotics (AFOs) compared to sensorimotor orthotics (SMOs) on children with cerebral palsy. 8 studies met the inclusion criteria. 6 out of 8 studies found a significant increase in stride length with orthotic use, regardless of duration. Results on gross motor skills effects were mixed, with 2 studies finding improvement and 1 finding no differences. No studies specifically examined the effects of SMOs. Overall, orthotics had generally positive effects on gait outcomes, but the literature lacks studies on SMOs and their effects.
This meta-analysis examined the influence of smoking on dental implant failure. The authors analyzed 19 relevant studies comprising over 10,000 implants. They found that smokers had over twice the odds of implant failure compared to non-smokers. Specifically, implants in the maxillary arch of smokers had over twice the odds of failure, while implants in the mandibular arch did not show a significant increased risk from smoking. This study revealed a significant relationship between smoking and risk of dental implant failure, particularly for implants located in the maxillary arch.
Cutting diathermy and ordinary scalpel for skin incision in open surgery whic...ahmadalmraezy
Cutting diathermy versus scalpel for skin incisions in open surgery: A systematic review and meta-analysis of 41 studies including 6422 patients found that compared to scalpel, diathermy resulted in significantly less blood loss, shorter incision and operative times, and lower postoperative pain scores, while risks of wound complications and hospital stay were comparable between the two techniques. Diathermy was associated with higher rates of seroma formation but no differences in other complications like infection, hematoma, or hernia.
Towards Replicable and Genereralizable Genomic Prediction ModelsLevi Waldron
Levi Waldron presents work on developing genomic prediction models and evaluating their performance across independent studies. Key points:
- Cross-validation often overestimates prediction accuracy compared to cross-study validation on independent datasets.
- Published genomic prediction models generally perform poorly when validated across independent studies, highlighting the need for "generalist" algorithms.
- Sources of heterogeneity between studies like differences in clinical factors or gene expression patterns can significantly impact prediction accuracy in cross-study validation.
- The lab has developed resources like curated datasets and the MultiAssayExperiment framework to facilitate integrative analysis of multi-omics cancer data from multiple independent studies.
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...DrHeena tiwari
This study compared the efficacy of a single 100mg transdermal diclofenac patch to a single 75mg intramuscular diclofenac injection for managing postoperative pain in 30 patients who underwent maxillofacial surgery. Patients were randomly assigned to receive either the patch or injection. Pain levels were assessed at various timepoints using a visual analogue scale. The results found that the patch provided longer lasting analgesia (15 hours on average) compared to the injection (9 hours), and fewer patients in the patch group required rescue pain medication. No local complications occurred with the patch. The study concluded that a single diclofenac patch was more effective than intramuscular diclofenac for managing immediate postoperative pain
This document summarizes bone cement implantation syndrome (BCIS), an important cause of intraoperative mortality and morbidity in patients undergoing cemented hip arthroplasty. The document proposes a definition and severity classification for BCIS. It reviews the incidence, clinical features, risk factors, pathophysiology, risk reduction strategies, and management of BCIS. High risk patients, such as those undergoing long-stem hip arthroplasty, are more likely to experience hypotension, hypoxia, or other complications from BCIS during cementation. Invasive monitoring should be considered for high risk patients undergoing cemented hip arthroplasty.
Bactericidal and Sporicidal Activities against Pathogenic Bacteria of Direct ...science journals
The purpose of this investigation was to examine the bactericidal activity of long lifetime ozone water (LLO water) against pathogenic bacteria of medical, veterinary, and public health interest.
Mean platelet volume and other platelet volume indices in patients with acute...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Impact of Drains on the Postoperative Sequel Following Third Molar Surgery: A...DrHeena tiwari
This document summarizes a study that assessed the impact of rubber drains on postoperative outcomes following third molar surgery. The study involved 60 patients who underwent bilateral third molar removal, with a drain placed on one side but not the other. Parameters like pain, swelling, trismus and infections were evaluated and compared between sides. The results found no significant differences between sides in any parameter, suggesting drains do not provide benefits. While some past studies found drains reduced sequelae, this study's findings did not support positive effects of drains on postoperative recovery from third molar surgery.
Predictive value of exercise myocardial perfusion imaging in the Medicare population: the impact of the ability to exercise
Authors: Deborah H. Kwon, Venu Menon, Penny Houghtaling, Elizabeth Lieber, Richard C. Brunken, Manuel D. Cerqueira, Wael A. Jaber
Oral Health & Its Effect on COVID 19: Systematic Review & Meta Analysis.DrHeena tiwari
This document summarizes a systematic review and meta-analysis on the relationship between oral health and COVID-19. The review included 13 studies. Key findings included:
1) Infection control measures like telephone screening, social distancing and PPE were discussed across many studies as important for dental practices during the pandemic.
2) Pre-procedural mouthwashes and use of rubber dams and high-volume evacuation were recommended to reduce aerosol transmission during dental procedures.
3) Guidelines varied on types of masks to use, but N95 or equivalent masks were suggested for aerosol-generating procedures by many studies.
4) Psychological impacts of COVID-19 on dental workers and appropriate waste
Short Term Outcomes after Use of Intracardiac Bone Stem Cell Transplantation ...crimsonpublishersOJCHD
Short Term Outcomes after Use of Intracardiac Bone Stem Cell Transplantation for Management of Heart Failure: A Meta-Analysis by Rohit SL in Open Journal of Cardiology & Heart Diseases
Intraoperative coronary angiography can be useful for assessing graft patency following coronary artery bypass surgery. It was found to detect important defects in 12% of grafts, including conduit defects in 6.8% of grafts and anastomotic defects in 3.7% of grafts. While it adds time and cost, it can guide necessary graft revisions. The complication rates of intraoperative angiography are low, around 4% for renal complications and 1% for infectious complications. However, intraoperative angiographic data needs to be interpreted cautiously, as clots, edema or hematomas could impact the images. Further research is still needed to determine the impact on long-term survival.
Role of Serum Copper and Zinc in Pathogenesis of Psoriasisiosrjce
IOSR Journal of Biotechnology and Biochemistry (IOSR-JBB) covers studies of the chemical processes in living organisms, structure and function of cellular components such as proteins, carbohydrates, lipids, nucleic acids and other biomolecules, chemical properties of important biological molecules, like proteins, in particular the chemistry of enzyme-catalyzed reactions, genetic code (DNA, RNA), protein synthesis, cell membrane transport, and signal transduction. IOSR-JBB is privileged to focus on a wide range of biotechnology as well as high quality articles on genetic engineering, cell and tissue culture technologies, genetics, microbiology, molecular biology, biochemistry, embryology, cell biology, chemical engineering, bioprocess engineering, information technology, biorobotics.
ABSTRACT- Introduction: Leprosy one of the oldest and chronic infectious disease caused by Mycobacterium
leprae. Leprosy is widely prevalent in India. Most of the cases present as hypopigmented patches or erythematous
lesions over skin. However on histopathology these lesions show a wide spectrum of changes and variations.
Material And Methods: A retrospective study of diagnosed cases of leprosy on skin biopsy in Department of
Pathology, S Nijalingappa Medical College from January 2015 to January 2016. Total of 63 cases were re-evaluated
and classified according to Ridley-Jopling classification.
Results: Lesions were most oftenly seen in middle aged patients and most common symptom was hypopigmented patch
(68.2%). Based on Ridley-Jopling classification, most cases were lepromatous leprosy (23.8%) followed by borderline
lepromatous type (22.2%), indeterminate type (22.2%), tuberculoid leprosy (6.3%), borderline tuberculoid leprosy
(17.4%) and borderline borderline leprosy (7.9%). Wade-Fite staining was done in 42 cases out of which 17 cases
showed positive for acid-fast bacilli. Also noted that the bacilli load was >2+ in lepromatous spectrum.
Conclusion: Histopathology remains the important tool to diagnose the subtype of leprosy lesions. Lepromatous
leprosy is most often associated with high bacterial load.
Key-words- Histomorphological Spectrum, Lepromatous spectrum, Mycobacterium leprae, Leprosy
This review paper analyzed 1300 publications in the Journal of Maxillofacial Oral Surgery from 2009 to 2020 to evaluate trends in levels of evidence. The analysis found that case reports and narrative reviews with a level D evidence accounted for 36% of publications. The majority (35%) of articles fell under maxillofacial pathology. The percentage of higher levels of evidence (A and B) increased from 2.09% in 2009/2010 to 12.74% in 2019/2020, indicating improving research quality over time. Categorizing publications by level of evidence and topic can help refine research quality in the journal going forward.
This paper presents a novel non-invasive method for glucose monitoring using impedance spectroscopy. The experimental setup involves measuring the impedance of Ringer's solution and human blood using a four-electrode system at varying glucose concentrations and frequencies. Results show voltage peaks occurring within a consistent frequency band for both Ringer's solution and human subjects, and that voltage increases with higher glucose levels. This establishes a relationship between blood glucose concentration and impedance. Further refinement is needed to account for other factors influencing impedance readings and improve accuracy for a full non-invasive glucose monitoring device.
Autologous Bone Marrow Mononuclear Cell Therapy for Autism: An Open Label Pro...DrAlokSharma
Autism spectrum disorders (ASD) are a group of heterogeneous neurodevelopmental disorders characterized by
deficits in verbal and nonverbal communication, social
interaction, and presence of stereotypical repetitive behavior.
Comparative Effects of Chewing Gums in Oral Health: An Original ResearchDrHeena tiwari
This study assessed the effects of sugar-free chewing gum on oral health by comparing plaque index and DMFT scores between patients who chewed gum daily versus a control group. Forty patients were divided into two groups - one using sugar-free gum for 20 minutes daily and a control group. Plaque index and DMFT scores were assessed monthly for both groups. The gum group showed significantly lower plaque accumulation and fewer caries incidents compared to the control group after two months. However, the benefits decreased after longer use, possibly due to decreased compliance. The study concluded that sugar-free gum can improve oral health when used regularly as an adjunct to brushing and flossing by stimulating saliva and reducing plaque and caries risk.
Use of static or articulating spacers for infectionmrcs89
This study systematically reviewed the literature to compare outcomes of static versus articulating antibiotic spacers for infection following total knee arthroplasty. The review identified 7 comparative studies and 32 case series. Results showed similar reinfection rates between static (12%) and articulating (7%) spacers. However, articulating spacers resulted in greater knee range of motion after reimplantation (101° vs 91°). Despite this difference, functional scores were similar between groups. Complication rates were also similar. The review found articulating spacers provided improved motion but did not clearly demonstrate superiority in infection eradication.
Union Rate of Tibiotalocalcaneal Nail with Internal or External Bone Stimulat...skisnfeet
This study compared the union rates of tibiotalocalcaneal (TTC) arthrodesis using an intramedullary nail with either internal or external bone stimulation. The study found that the union rates were similar between internal (53%) and external (57%) bone stimulation. Additionally, the rates of successful fusion capable of independent ambulation were similar between internal (81%) and external (83%) groups. While time to partial weight bearing was slightly faster with internal stimulation, there were no other significant differences in outcomes between the two bone stimulation methods.
Towards Replicable and Genereralizable Genomic Prediction ModelsLevi Waldron
Levi Waldron presents work on developing genomic prediction models and evaluating their performance across independent studies. Key points:
- Cross-validation often overestimates prediction accuracy compared to cross-study validation on independent datasets.
- Published genomic prediction models generally perform poorly when validated across independent studies, highlighting the need for "generalist" algorithms.
- Sources of heterogeneity between studies like differences in clinical factors or gene expression patterns can significantly impact prediction accuracy in cross-study validation.
- The lab has developed resources like curated datasets and the MultiAssayExperiment framework to facilitate integrative analysis of multi-omics cancer data from multiple independent studies.
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...DrHeena tiwari
This study compared the efficacy of a single 100mg transdermal diclofenac patch to a single 75mg intramuscular diclofenac injection for managing postoperative pain in 30 patients who underwent maxillofacial surgery. Patients were randomly assigned to receive either the patch or injection. Pain levels were assessed at various timepoints using a visual analogue scale. The results found that the patch provided longer lasting analgesia (15 hours on average) compared to the injection (9 hours), and fewer patients in the patch group required rescue pain medication. No local complications occurred with the patch. The study concluded that a single diclofenac patch was more effective than intramuscular diclofenac for managing immediate postoperative pain
This document summarizes bone cement implantation syndrome (BCIS), an important cause of intraoperative mortality and morbidity in patients undergoing cemented hip arthroplasty. The document proposes a definition and severity classification for BCIS. It reviews the incidence, clinical features, risk factors, pathophysiology, risk reduction strategies, and management of BCIS. High risk patients, such as those undergoing long-stem hip arthroplasty, are more likely to experience hypotension, hypoxia, or other complications from BCIS during cementation. Invasive monitoring should be considered for high risk patients undergoing cemented hip arthroplasty.
Bactericidal and Sporicidal Activities against Pathogenic Bacteria of Direct ...science journals
The purpose of this investigation was to examine the bactericidal activity of long lifetime ozone water (LLO water) against pathogenic bacteria of medical, veterinary, and public health interest.
Mean platelet volume and other platelet volume indices in patients with acute...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Impact of Drains on the Postoperative Sequel Following Third Molar Surgery: A...DrHeena tiwari
This document summarizes a study that assessed the impact of rubber drains on postoperative outcomes following third molar surgery. The study involved 60 patients who underwent bilateral third molar removal, with a drain placed on one side but not the other. Parameters like pain, swelling, trismus and infections were evaluated and compared between sides. The results found no significant differences between sides in any parameter, suggesting drains do not provide benefits. While some past studies found drains reduced sequelae, this study's findings did not support positive effects of drains on postoperative recovery from third molar surgery.
Predictive value of exercise myocardial perfusion imaging in the Medicare population: the impact of the ability to exercise
Authors: Deborah H. Kwon, Venu Menon, Penny Houghtaling, Elizabeth Lieber, Richard C. Brunken, Manuel D. Cerqueira, Wael A. Jaber
Oral Health & Its Effect on COVID 19: Systematic Review & Meta Analysis.DrHeena tiwari
This document summarizes a systematic review and meta-analysis on the relationship between oral health and COVID-19. The review included 13 studies. Key findings included:
1) Infection control measures like telephone screening, social distancing and PPE were discussed across many studies as important for dental practices during the pandemic.
2) Pre-procedural mouthwashes and use of rubber dams and high-volume evacuation were recommended to reduce aerosol transmission during dental procedures.
3) Guidelines varied on types of masks to use, but N95 or equivalent masks were suggested for aerosol-generating procedures by many studies.
4) Psychological impacts of COVID-19 on dental workers and appropriate waste
Short Term Outcomes after Use of Intracardiac Bone Stem Cell Transplantation ...crimsonpublishersOJCHD
Short Term Outcomes after Use of Intracardiac Bone Stem Cell Transplantation for Management of Heart Failure: A Meta-Analysis by Rohit SL in Open Journal of Cardiology & Heart Diseases
Intraoperative coronary angiography can be useful for assessing graft patency following coronary artery bypass surgery. It was found to detect important defects in 12% of grafts, including conduit defects in 6.8% of grafts and anastomotic defects in 3.7% of grafts. While it adds time and cost, it can guide necessary graft revisions. The complication rates of intraoperative angiography are low, around 4% for renal complications and 1% for infectious complications. However, intraoperative angiographic data needs to be interpreted cautiously, as clots, edema or hematomas could impact the images. Further research is still needed to determine the impact on long-term survival.
Role of Serum Copper and Zinc in Pathogenesis of Psoriasisiosrjce
IOSR Journal of Biotechnology and Biochemistry (IOSR-JBB) covers studies of the chemical processes in living organisms, structure and function of cellular components such as proteins, carbohydrates, lipids, nucleic acids and other biomolecules, chemical properties of important biological molecules, like proteins, in particular the chemistry of enzyme-catalyzed reactions, genetic code (DNA, RNA), protein synthesis, cell membrane transport, and signal transduction. IOSR-JBB is privileged to focus on a wide range of biotechnology as well as high quality articles on genetic engineering, cell and tissue culture technologies, genetics, microbiology, molecular biology, biochemistry, embryology, cell biology, chemical engineering, bioprocess engineering, information technology, biorobotics.
ABSTRACT- Introduction: Leprosy one of the oldest and chronic infectious disease caused by Mycobacterium
leprae. Leprosy is widely prevalent in India. Most of the cases present as hypopigmented patches or erythematous
lesions over skin. However on histopathology these lesions show a wide spectrum of changes and variations.
Material And Methods: A retrospective study of diagnosed cases of leprosy on skin biopsy in Department of
Pathology, S Nijalingappa Medical College from January 2015 to January 2016. Total of 63 cases were re-evaluated
and classified according to Ridley-Jopling classification.
Results: Lesions were most oftenly seen in middle aged patients and most common symptom was hypopigmented patch
(68.2%). Based on Ridley-Jopling classification, most cases were lepromatous leprosy (23.8%) followed by borderline
lepromatous type (22.2%), indeterminate type (22.2%), tuberculoid leprosy (6.3%), borderline tuberculoid leprosy
(17.4%) and borderline borderline leprosy (7.9%). Wade-Fite staining was done in 42 cases out of which 17 cases
showed positive for acid-fast bacilli. Also noted that the bacilli load was >2+ in lepromatous spectrum.
Conclusion: Histopathology remains the important tool to diagnose the subtype of leprosy lesions. Lepromatous
leprosy is most often associated with high bacterial load.
Key-words- Histomorphological Spectrum, Lepromatous spectrum, Mycobacterium leprae, Leprosy
This review paper analyzed 1300 publications in the Journal of Maxillofacial Oral Surgery from 2009 to 2020 to evaluate trends in levels of evidence. The analysis found that case reports and narrative reviews with a level D evidence accounted for 36% of publications. The majority (35%) of articles fell under maxillofacial pathology. The percentage of higher levels of evidence (A and B) increased from 2.09% in 2009/2010 to 12.74% in 2019/2020, indicating improving research quality over time. Categorizing publications by level of evidence and topic can help refine research quality in the journal going forward.
This paper presents a novel non-invasive method for glucose monitoring using impedance spectroscopy. The experimental setup involves measuring the impedance of Ringer's solution and human blood using a four-electrode system at varying glucose concentrations and frequencies. Results show voltage peaks occurring within a consistent frequency band for both Ringer's solution and human subjects, and that voltage increases with higher glucose levels. This establishes a relationship between blood glucose concentration and impedance. Further refinement is needed to account for other factors influencing impedance readings and improve accuracy for a full non-invasive glucose monitoring device.
Autologous Bone Marrow Mononuclear Cell Therapy for Autism: An Open Label Pro...DrAlokSharma
Autism spectrum disorders (ASD) are a group of heterogeneous neurodevelopmental disorders characterized by
deficits in verbal and nonverbal communication, social
interaction, and presence of stereotypical repetitive behavior.
Comparative Effects of Chewing Gums in Oral Health: An Original ResearchDrHeena tiwari
This study assessed the effects of sugar-free chewing gum on oral health by comparing plaque index and DMFT scores between patients who chewed gum daily versus a control group. Forty patients were divided into two groups - one using sugar-free gum for 20 minutes daily and a control group. Plaque index and DMFT scores were assessed monthly for both groups. The gum group showed significantly lower plaque accumulation and fewer caries incidents compared to the control group after two months. However, the benefits decreased after longer use, possibly due to decreased compliance. The study concluded that sugar-free gum can improve oral health when used regularly as an adjunct to brushing and flossing by stimulating saliva and reducing plaque and caries risk.
Use of static or articulating spacers for infectionmrcs89
This study systematically reviewed the literature to compare outcomes of static versus articulating antibiotic spacers for infection following total knee arthroplasty. The review identified 7 comparative studies and 32 case series. Results showed similar reinfection rates between static (12%) and articulating (7%) spacers. However, articulating spacers resulted in greater knee range of motion after reimplantation (101° vs 91°). Despite this difference, functional scores were similar between groups. Complication rates were also similar. The review found articulating spacers provided improved motion but did not clearly demonstrate superiority in infection eradication.
Union Rate of Tibiotalocalcaneal Nail with Internal or External Bone Stimulat...skisnfeet
This study compared the union rates of tibiotalocalcaneal (TTC) arthrodesis using an intramedullary nail with either internal or external bone stimulation. The study found that the union rates were similar between internal (53%) and external (57%) bone stimulation. Additionally, the rates of successful fusion capable of independent ambulation were similar between internal (81%) and external (83%) groups. While time to partial weight bearing was slightly faster with internal stimulation, there were no other significant differences in outcomes between the two bone stimulation methods.
Two observational studies were included in a meta-analysis examining the association between fluoroquinolone use and risk of aortic dissection or aneurysm. The studies found current fluoroquinolone use was associated with a significantly increased risk of aortic dissection (OR 2.79) and aneurysm (OR 2.25). The number needed to harm for aortic aneurysms in elderly patients was estimated to be 618. The evidence was rated as moderate quality based on the strengths and limitations of the observational studies.
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
This study compared two methods of fixing polypropylene mesh during open inguinal hernia repair surgery: fibrin glue fixation versus suture fixation. The study included 60 patients undergoing unilateral inguinal hernia repair who were divided into two groups. The results showed that surgery time was significantly shorter when using fibrin glue fixation compared to suture fixation. Patients who received fibrin glue fixation also reported significantly less pain in the first post-operative day, first post-operative week, and one month after surgery. There were no significant differences in complications between the two groups. The study concluded that fibrin glue provided an effective alternative to sutures for fixing mesh with benefits including shorter surgery time and less post-operative pain.
Clustering-Aided Approach for Predicting Patient Outcomes with Application to...Mahmoud Elbattah
Presented at Workshop on Health Intelligence (W3PHIAI) - AAAI 2017 Conference
https://aaai.org/ocs/index.php/WS/AAAIW17/paper/view/15188
Authors:
Mahmoud Elbattah and Owen Molloy
National University of Ireland Galway
mahmoud.elbattah@nuigalway.ie
1) The study investigated the effectiveness of platelet-rich plasma (PRP) combined with core decompression and allogeneic fibula rod support for treating osteonecrosis of the femoral head (ONFH).
2) Patients treated with PRP in addition to core decompression and rod support showed significantly improved Harris hip scores after surgery, with no differences compared to the control group that did not receive PRP.
3) Imaging at 3 months post-surgery found no deformities or collapses in either group, with the fibula rods properly positioned and beginning to integrate with surrounding bone.
20221026 implant LL - Association of prosthetic features and peri-implantitis...CurtisWeng1
1) The study analyzed the relationship between various prosthetic features and risk of peri-implantitis, based on clinical records of implant patients.
2) Key findings were that emergence profile angles over 30 degrees, convex emergence profiles, and implants splinted between adjacent implants (middle position) were associated with greater risk of peri-implantitis.
3) A predictive model suggested emergence angle, profile, and splinting position could help estimate peri-implantitis prevalence.
This study developed a preoperative risk model to predict the occurrence of postoperative pneumonia in patients undergoing coronary artery bypass grafting (CABG). Researchers analyzed data on over 16,000 CABG patients from 33 hospitals. Postoperative pneumonia occurred in 3.3% of patients. The final model identified 17 preoperative factors that were significantly associated with increased risk of pneumonia, including demographics, laboratory values, comorbid diseases, pulmonary function, and cardiac function/anatomy. The model had good discrimination (C-statistic of 0.74) and performed well in validation analyses. This risk model can help provide individualized risk estimates and identify opportunities to reduce preoperative pneumonia risk.
Hammer Toe Correction Comparative StudyWenjay Sung
This study compared outcomes of 3 surgical treatments for hammertoe deformities: arthroplasty, arthrodesis, and interpositional implant arthroplasty. 114 patients underwent one of the procedures and were followed for at least 12 months. All treatments significantly improved pain and sagittal plane correction, but only implant arthroplasty provided significant transverse plane correction and had the lowest revision rate at 10.4%. The study demonstrates implant arthroplasty may have advantages over the other procedures for hammertoe correction.
British Journal of Anaesthesia, 120(1) 146e155 (2018)doiVannaSchrader3
British Journal of Anaesthesia, 120(1): 146e155 (2018)
doi: 10.1016/j.bja.2017.08.002
Advance Access Publication Date: 23 November 2017
Quality and Safety
Q U A L I T Y A N D S A F E T Y
The surgical safety checklist and patient outcomes
after surgery: a prospective observational cohort
study, systematic review and meta-analysis
T.E.F. Abbott1, T. Ahmad1, M.K. Phull2, A.J. Fowler3, R. Hewson2,
B.M. Biccard4, M.S. Chew5, M. Gillies6 and R.M. Pearse1,*, for the
International Surgical Outcomes Study (ISOS) groupa
1William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK, 2The Royal
London Hospital, Barts Health NHS Trust, London E1 1BB, UK, 3Guys and St. Thomas’s NHS Foundation
Trust, London SE1 7EH, UK, 4Department of Anaesthesia and Perioperative Medicine, Groote Schuur
Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, 5Department of
Anaesthesia and Intensive Care, Faculty of Medicine and Health Sciences, Link€oping University, 58185
Link€oping, Sweden and 6Department of Anaesthesia, Critical Care and Pain Medicine, University of
Edinburgh, Edinburgh EH48 3DF, UK
*Corresponding author. E-mail: [email protected]
a Complete details for the collab authors are available in Supplementary data.
Abstract
Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians
continue to debate the clinical effectiveness of this tool.
Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international obser-
vational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published
literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the
secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear
model was used to test associations. To further contextualise these findings, we included the results from the ISOS
cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals.
Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%)
patients exposed to the checklist, whilst 7508 (16.8%) sustained �1 postoperative complications and 207 (0.5%) died
before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32e0.77);
P<0.01], but no difference in complication rates [OR 1.02 (0.88e1.19); P¼0.75]. In a systematic review, we screened 3732
records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated
with both reduced postoperative mortality [OR 0.75 (0.62e0.92); P<0.01; I2¼87%] and reduced complication rates [OR 0.73
(0.61e0.88); P<0.01; I2¼89%).
Conclusions: Patients exposed to a surgical safety checklist experience bett ...
Predictive Value of Surgical Safety Checklist and Operating Room (OR) briefin...Ruby Med Plus
Health care is complex, with several interdisciplinary elements, incredibly unpredictable and at high risk of hazard. Healthcare environments are complex and tightly coupled systems that have proven to be error-prone . Patients expect to be reasonably safe when under medical supervision . In 1999, the US based, Institute of Medicine report, To Err is Human, claimed that between 44.000 and 98.000 patients in the US die every year from preventable adverse events.
However regardless of an ongoing push for drastic improvement of the safety culture in healthcare, medical errors continue to occur at unacceptable rates .
The rising cost of health care is given progressively more importance worldwide. A major factor affecting hospital cost is complications following surgery . Surgical care is an integral part of health care throughout the world, with an estimated 234 million operations performed annually . Surgical complications are a considerable cause of death and disability around the world. The World Bank reported that in 2002, an estimated 164 million disability-adjusted life years, representing 11% of the entire disease burden, were attributable to surgically treatable conditions . Surgical complications are devastating to patients, costly to health care systems, and often preventable, though their prevention typically requires a change in systems and individual behavior.
This document discusses evidence-based practice and how it applies to assessing clinical intervention studies. It begins by listing the learning objectives for Lecture c, which include explaining how evidence-based medicine can be applied to intervention studies. The document then discusses how the best evidence for assessing interventions comes from randomized controlled trials (RCTs) or systematic reviews of RCTs. It provides examples of RCTs and outlines key questions one should ask to critically appraise an intervention study, such as whether the results are valid and can be applied to patient care.
Tashia Seeba - Antibiotics and maxillofacial fractures Tashia Seeba
This study evaluated the necessity of routine antibiotic administration to prevent surgical wound infections in patients undergoing treatment for maxillofacial fractures. The study retrospectively analyzed 67 patients with 114 fractures who were divided into 3 groups: no antibiotics, penicillin antibiotics, or cefotaxime antibiotics. The overall surgical wound infection rate was 16.66%. Statistical analysis found no significant difference in infection rates between the groups, suggesting that prophylactic antibiotics may not alter the risk of surgical wound infections in patients with maxillofacial fractures. Delay in treatment and use of catgut sutures were found to have a positive correlation with higher infection rates.
The document is a systematic review and meta-analysis that examines the association between extravascular lung water (EVLW) measured by transpulmonary thermodilution and mortality in critically ill patients. Eighteen studies including over 1,200 patients were analyzed. The pooled odds ratio from eleven studies showed EVLW was associated with a 69% higher risk of death. EVLW levels were also significantly lower in survivors compared to non-survivors, with a mean difference of nearly 5 mL/kg. Subgroup analyses found consistent results regardless of when EVLW was measured or patient characteristics. However, the certainty of evidence was low due to risk of bias in many studies. In conclusion, higher EVLW levels are
This document summarizes 5 research studies related to preventing post-surgical MRSA infections in acute care hospitals. The studies examined: (1) risk factors for vascular surgical site infections and preventative measures, (2) guidelines for controlling and preventing MRSA in healthcare facilities, (3) non-pharmacological interventions for preventing hospital-acquired infections, (4) the relationship between infection rates, procedures, antimicrobial use and bacterial resistance in an ICU, and (5) the impact of active MRSA screening and decolonization protocols on surgical site infections. The studies found that hand hygiene, screening protocols, limiting unnecessary procedures and antimicrobial use, and bundled infection control strategies can effectively reduce the rate of post-
This study examines a two-stage revision technique using antibiotic-impregnated cement spacers to treat chronically infected total knee arthroplasties. 45 infected knee prostheses underwent revision, with a minimum 5-year follow-up. The technique involved removal of the infected prosthesis and placement of an antibiotic cement spacer. After infection clearance, the spacer was removed and a new prosthesis implanted. Infection was eradicated in 95.6% of cases, with significant pain reduction and functional improvement. While sometimes requiring extensive surgical approaches, this two-stage technique remains the standard treatment for chronic knee prosthesis infection.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdfSelcen Ozturkcan
Ozturkcan, S., Berndt, A., & Angelakis, A. (2024). Mending clothing to support sustainable fashion. Presented at the 31st Annual Conference by the Consortium for International Marketing Research (CIMaR), 10-13 Jun 2024, University of Gävle, Sweden.
The cost of acquiring information by natural selectionCarl Bergstrom
This is a short talk that I gave at the Banff International Research Station workshop on Modeling and Theory in Population Biology. The idea is to try to understand how the burden of natural selection relates to the amount of information that selection puts into the genome.
It's based on the first part of this research paper:
The cost of information acquisition by natural selection
Ryan Seamus McGee, Olivia Kosterlitz, Artem Kaznatcheev, Benjamin Kerr, Carl T. Bergstrom
bioRxiv 2022.07.02.498577; doi: https://doi.org/10.1101/2022.07.02.498577
ESA/ACT Science Coffee: Diego Blas - Gravitational wave detection with orbita...Advanced-Concepts-Team
Presentation in the Science Coffee of the Advanced Concepts Team of the European Space Agency on the 07.06.2024.
Speaker: Diego Blas (IFAE/ICREA)
Title: Gravitational wave detection with orbital motion of Moon and artificial
Abstract:
In this talk I will describe some recent ideas to find gravitational waves from supermassive black holes or of primordial origin by studying their secular effect on the orbital motion of the Moon or satellites that are laser ranged.
ESR spectroscopy in liquid food and beverages.pptxPRIYANKA PATEL
With increasing population, people need to rely on packaged food stuffs. Packaging of food materials requires the preservation of food. There are various methods for the treatment of food to preserve them and irradiation treatment of food is one of them. It is the most common and the most harmless method for the food preservation as it does not alter the necessary micronutrients of food materials. Although irradiated food doesn’t cause any harm to the human health but still the quality assessment of food is required to provide consumers with necessary information about the food. ESR spectroscopy is the most sophisticated way to investigate the quality of the food and the free radicals induced during the processing of the food. ESR spin trapping technique is useful for the detection of highly unstable radicals in the food. The antioxidant capability of liquid food and beverages in mainly performed by spin trapping technique.
(June 12, 2024) Webinar: Development of PET theranostics targeting the molecu...Scintica Instrumentation
Targeting Hsp90 and its pathogen Orthologs with Tethered Inhibitors as a Diagnostic and Therapeutic Strategy for cancer and infectious diseases with Dr. Timothy Haystead.
Travis Hills of MN is Making Clean Water Accessible to All Through High Flux ...Travis Hills MN
By harnessing the power of High Flux Vacuum Membrane Distillation, Travis Hills from MN envisions a future where clean and safe drinking water is accessible to all, regardless of geographical location or economic status.
Describing and Interpreting an Immersive Learning Case with the Immersion Cub...Leonel Morgado
Current descriptions of immersive learning cases are often difficult or impossible to compare. This is due to a myriad of different options on what details to include, which aspects are relevant, and on the descriptive approaches employed. Also, these aspects often combine very specific details with more general guidelines or indicate intents and rationales without clarifying their implementation. In this paper we provide a method to describe immersive learning cases that is structured to enable comparisons, yet flexible enough to allow researchers and practitioners to decide which aspects to include. This method leverages a taxonomy that classifies educational aspects at three levels (uses, practices, and strategies) and then utilizes two frameworks, the Immersive Learning Brain and the Immersion Cube, to enable a structured description and interpretation of immersive learning cases. The method is then demonstrated on a published immersive learning case on training for wind turbine maintenance using virtual reality. Applying the method results in a structured artifact, the Immersive Learning Case Sheet, that tags the case with its proximal uses, practices, and strategies, and refines the free text case description to ensure that matching details are included. This contribution is thus a case description method in support of future comparative research of immersive learning cases. We then discuss how the resulting description and interpretation can be leveraged to change immersion learning cases, by enriching them (considering low-effort changes or additions) or innovating (exploring more challenging avenues of transformation). The method holds significant promise to support better-grounded research in immersive learning.
Current Ms word generated power point presentation covers major details about the micronuclei test. It's significance and assays to conduct it. It is used to detect the micronuclei formation inside the cells of nearly every multicellular organism. It's formation takes place during chromosomal sepration at metaphase.
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...Sérgio Sacani
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
Results. The EWOCS X-ray catalog comprises 5963 validated sources out of the 9420 initially provided to ACIS-Extract, reaching a
photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
with 1075 sources located within the central 1 arcmin. We have successfully detected X-ray emissions from 126 out of the 166 known
massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
Sexuality - Issues, Attitude and Behaviour - Applied Social Psychology - Psyc...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
2. combinations of keywords “tibia pylon/plafond”, “fracture?”,
“ExFix”, “internal fixation”, “ORIF” and “comparative study”. The
language was restricted to English. We also scanned the citation
lists of the identified articles for additional relevant studies.
Eligibility
Studies were included if they met the following criteria: (1)
randomized, quasi-randomized, prospective and retrospective
cohort and case-control studies; (2) patients with tibial pilon
fractures of type 43A, 43B, 43C according to the AO/OTA classifi-
cation; (3) patients aged 18 years or older; (4) comparison of ORIF
and ExFix for treatment; (5) outcomes of interest adequately re-
ported for meta-analysis.
Data extraction and study quality assessment
Full texts were read and relevant data were extracted from each
included study by the two authors independently using a data
extraction form. The information extracted from each study
included the first author, year, country, research type, patients'
number. Outcomes of interest we extracted included the incidence
of complications, the union time and unplanned hardware
removal. After the first extraction, the data were rechecked by the
two authors.
The quality of the included studies was assessed by the two
independent observers, using the Downs and Black checklist for
both randomized and nonrandomized studies.8
For the Downs
and Black checklist, 27 questions were raised to assess reporting,
external validity, internal validity-bias, internal validity-
confounding, and power. This checklist is considered a reliable
and valid tool to assess the methodological quality of studies,
which has a total score of 31. Scores above 20 were considered high
methodological quality; 11e20 moderate quality; and below 11
poor quality.
Statistical analysis
Statistical analyses were done using Review Manager Version
5.2 (Cochrane Collaboration, Software Update, Oxford). We
analyzed the risk ratio (RR) with 95% confidence intervals (CI) for
dichotomous variables and the weighted mean difference (WMD)
with the 95% CI for continuous variables. I-squared (I2
) statistic was
used to assess statistical heterogeneity among studies and I2
> 50%
reflects high heterogeneity.9
Both fixed-effects and random-effects
models were used to pool the data. The random-effects model was
used only when heterogeneity was significant. p-values less than
0.05 are considered statistically significant.
Results
A total of eleven studies,7,10e19
compared ORIF and ExFix for
tibial pilon fractures and published between 1993 and 2013, ful-
filled our inclusion criteria. Fig. 1 provides a flow diagram of the
search results. These studies included 502 participants, of which
238 (47.4%) underwent ExFix and 264 (52.6%) underwent ORIF. The
study consisted of ten retrospective or prospective non-
randomized studies and one randomized clinical trial. Results of
quality assessment with the Downs and Black checklist are shown
in Table 1. Total scores were on average 16.3 points. Ten of eleven
studies were of moderate methodological quality, while one of
poor quality. All eleven studies were of low power due to small
intervention group sizes. A summary of meta-analysis results is
shown in Table 2.
Postoperative complications
Infection
Eleven studies7,10e19
reported the incidence of wound in-
fections, with only two of them individually showing a statistically
significant difference between the ExFix group and the ORIF group.
One study did not give the detailed data and was excluded from
analysis. Rate of total infection was 43 of 225 in the ExFix group
and 35 of 250 in the ORIF group. Subgroup analysis showed a
higher risk of incidence of superficial infection in the ExFix group
(RR ¼ 2.71, 95% CI ¼ 1.48 to 4.97, Chi2
¼ 5.65, p ¼ 0.001) with no
significant heterogeneity (I2
¼ 0%), while for deep infection there
was no difference between the two groups (RR ¼ 0.65, 95%
CI ¼ 0.37 to 1.14, Chi2
¼ 12.99, p ¼ 0.13) with an acceptable het-
erogeneity (I2
¼ 31%). The forest plot is presented in Fig. 2.
Post-traumatic arthrosis
Arthrosis was a major complication reported by seven stud-
ies.10,12,15e19
Rate of arthrosis was higher in the ORIF group (57 of
144) than that of the ExFix group (55 of 159). Meta-analysis
showed no significant difference in the incidence of arthrosis be-
tween the ExFix group and the ORIF group. The result was
RR ¼ 0.98, 95% CI ¼ 0.79 to 1.23, Chi2
¼ 6.88, I2
¼ 13%, p ¼ 0.87.
Malunion
Malunion was defined as >5 of angulation in the coronal plane,
10 in the sagittal plane, or 2 mm of articular step-off as seen on
postoperative radiographs. Six studies7,14e17,19
reported the inci-
dence of malunion, none of which individually showed a statisti-
cally significant difference between the ExFix group and the ORIF
group. The meta-analysis of these studies showed a significantly
reduced incidence of malunion with ORIF as compared with ExFix
(RR ¼ 2.85, 95% CI ¼ 1.23 to 6.60, Chi2
¼ 1.32, p ¼ 0.01) with no
significant heterogeneity (I2
¼ 33%).
Fig. 1. Flow chart of screening studies comparing ORIF and ExFix.
Y.-C. Meng, X.-H. Zhou / Chinese Journal of Traumatology xxx (2016) 1e52
Please cite this article in press as: Meng Y-C, Zhou X-H, External fixation versus open reduction and internal fixation for tibial pilon fractures: A
meta-analysis based on observational studies, Chinese Journal of Traumatology (2016), http://dx.doi.org/10.1016/j.cjtee.2016.06.002
3. Nonunion
Nonunion was defined as a fracture that did not heal in six
months. A total of six studies7,13e15,17,18
reported the incidence of
nonunion. Meta-analysis showed a significantly higher risk of
nonunion in ExFix groups with a moderate heterogeneity
(RR ¼ 2.09, 95% CI ¼ 1.10 to 3.98, Chi2
¼ 7.49, I2
¼ 33%, p ¼ 0.02).
Unplanned hardware removal
Postoperative infection or osteomyelitis was usually treated by
additional secondary procedures including unplanned hardware
removal. The rate of unplanned hardware removal was reported by
five studies.12,14,15,17,19
Meta-analysis detected an increased risk of
unplanned hardware removal in the ORIF group with no significant
heterogeneity among the studies (RR ¼ 0.12, 95% CI ¼ 0.04 to 0.37,
Chi2
¼ 2.01, I2
¼ 0%, p ¼ 0.0002).
Union time
Union time was compared in four studies,13,14,16,17
and one of
them13
was excluded because of not mentioning the standard
Table 1
Methodological quality assessment of included studies based on the Downs and
Black checklist.
First author, year Reporting
0e10
External
validity
0e3
Bias
0e7
Confounding
0e6
Power
0e5
Total
0e31
Bonar,10
1993 5 1 2 2 0 10
Crutchfield,11
1995
7 2 4 3 0 16
Wyrsch,12
1996 8 1 5 4 0 18
Anglen,13
1999 9 1 4 2 0 16
Pugh,14
1999 7 2 4 2 0 15
Bocchi,19
2000 7 1 5 3 0 16
Watson,15
2000 9 1 4 3 0 17
Harris,7
2006 9 2 4 2 0 17
Koulouvaris,16
2007
9 2 5 3 0 19
Bacon,17
2008 8 1 4 3 0 16
Richards,18
2012 10 2 4 3 0 19
Mean (SD) 8 (1.4) 1.5 (0.5) 4.1 (0.8) 2.7 (0.6) 0.0 (0.0) 16.3 (2.5)
Table 2
Summary of meta-analysis of ORIF versus ExFix.
Items Test for heterogeneity Analysis model Test for overall effect RR or WMD 95% CI
I2
p Z p
Superficial infection 0% 0.46 Fixed 3.23 0.001 2.71 (1.48,4.97)
Deep infection 31% 0.16 Fixed 1.51 0.13 0.65 (0.37,1.14)
Reduction 0% 0.50 Fixed 1.60 0.11 0.89 (0.76,1.03)
Arthrosis 13% 0.33 Fixed 0.16 0.87 0.98 (0.79,1.23)
Malunion 0% 0.93 Fixed 2.44 0.01 2.85(1.23,6.60)
Nonunion 33% 0.19 Fixed 2.24 0.02 2.09 (1.10,3.98)
Hardware removal 0% 0.73 Fixed 3.71 0.0002 0.12 (0.04,0.37)
Union time 70% 0.04 Random 0.93 0.35 4.35 (À4.80,13.50)
Clinical evaluation 36% 0.21 Fixed 0.23 0.82 1.03 (0.82,1.28)
Abbreviations: ExFix, external fixation; ORIF, open reduction and internal fixation; RR, risk ratio; WMD, weighted mean difference; CI, confidence interval.
Fig. 2. Meta-analysis of postoperative infection between ExFix and ORIF. Diamonds represent pooled estimates and width of the diamonds represents 95% CI.
Y.-C. Meng, X.-H. Zhou / Chinese Journal of Traumatology xxx (2016) 1e5 3
Please cite this article in press as: Meng Y-C, Zhou X-H, External fixation versus open reduction and internal fixation for tibial pilon fractures: A
meta-analysis based on observational studies, Chinese Journal of Traumatology (2016), http://dx.doi.org/10.1016/j.cjtee.2016.06.002
4. deviation. Meta-analysis of the other three studies revealed no
significant difference regarding union time (RR ¼ 4.35, 95%
CI ¼ À4.80 to 13.50, Chi2
¼ 6.69, p ¼ 0.35) and the heterogeneity
was significant (I2
¼ 70%).
Radiography results
Assessment of reduction was based on postoperative radio-
graphs. Reduction was designated as excellent or anatomic if there
was less than 2 mm of gap or step-off, less than 1 mm of mortise
asymmetry, and normal alignment; poor if there was more than
4 mm of gap or step-off, more than 2 mm of asymmetry.13,20
We
studied the number of patients who were graded as excellent or
anatomic in both groups. A total of six studies10,12,13,15,18,19
measured and compared the reduction score. The meta-analysis
did not reveal any difference between groups (RR ¼ 0.89, 95%
CI ¼ 0.76 to 1.03, Chi2
¼ 4.32, I2
¼ 0%, p ¼ 0.11).
Clinical evaluation
A total of seven studies7,11e13,15,18,19
described the clinical eval-
uation results of both groups, but only two of them15,19
used the
same scoring system which was modified by Teeny and Wiss.21
Meta-analysis of these two studies did not show a significant dif-
ference in clinical evaluation between the two groups (RR ¼ 1.03,
95% CI ¼ 0.82 to 1.28, Chi2
¼ 1.56, I2
¼ 36%, p ¼ 0.82).
Publication bias
Funnel plots of standard error (SE) versus RR for outcome which
included more than nine studies were made. For infection, visual
inspection of the funnel plots did not show any remarkable
asymmetry, which indicated no significant publication bias. The
funnel plot is presented in Fig. 3.
Discussion
Tibial pilon fracture is a severe injury with many different
complications. Treatments of the injury have evolved for a long
time but there is still not a gold standard for surgeons to follow.
ORIF, the most reliable means to obtain excellent reduction of the
articular surface, has been advocated since the mid-60s, but the
strict steps of meticulous reduction and rigid fixation have gradu-
ally made the surgeon reluctant to use this method. The application
of ExFix provided indirect ways of reduction and protection for the
soft tissue. Few comparative studies between ORIF and ExFix
concluded that ExFix was involved in fewer complications, while
some other studies had opposite results. According to our knowl-
edge, no meta-analysis compared the difference between ExFix and
ORIF.
Our systematic review and meta-analysis included eleven
studies, one prospective randomized and ten retrospective cohort
comparing ORIF versus ExFix for tibial pilon fractures. The results
of this meta-analysis of all eleven studies suggest that there is no
statistically significant difference of the total postoperative infec-
tion between the ORIF and the ExFix group. Subgroup analysis of
deep infection did not find a significant difference between the
two groups, but when only superficial infection was considered,
the incidence increased in the ExFix group. Only one study13
re-
ported the operation time and blood loss and both outcomes
showed no significant difference between two groups. Union time
was compared by four studies. One of them reported that ORIF
group took less time to union (p 0.05) and did not describe the
standard deviation. Meta-analysis of other three studies revealed
no significant difference between the two treatment groups, but
with a significant heterogeneity (I2
¼ 70%), which limited the
reliability of the result. The source of heterogeneity is probably due
to using an external Ilizarov ring fixator, which may result in a
reduced union time in ExFix groups.17
Arthrosis is also a major
complication, which could lead to amputation and other addi-
tional operations. Our analysis showed no significant difference in
the incidence of post-traumatic arthrosis between both groups
(p ¼ 0.87). There is a significant reduction of incidence of malunion
in ORIF groups (4.3%) versus ExFix groups (12%). Nonunion is a
multifactorial complication caused by ignoring contraindications,
unfavorable biomechanical and vascular conditions.22
The inci-
dence rate of nonunion was compared by six studies and meta-
analysis showed a significantly higher risk of nonunion in ExFix
groups with an acceptable heterogeneity (p ¼ 0.02). It was re-
ported that smoking was a risk factor for nonunion of femoral neck
fractures.23
Bacon et al17
stratified the complications according to
the risk factor of smokers versus non-smokers and found no sta-
tistically significant association between a positive cigarette his-
tory and nonunion (p ¼ 0.44). Additional secondary procedures
such as unplanned hardware removal were also considerable fac-
tors for surgeons to select the operation. Many reasons lead to
unplanned hardware removal, including deep infection and oste-
omyelitis. Meta-analysis showed a significantly reduced un-
planned hardware removal rate in ExFix groups (RR ¼ 0.12, 95%
CI ¼ 0.04 to 0.37, Chi2
¼ 2.01, I2
¼ 0%, p ¼ 0.0002). More hardware
was fixed in legs in ORIF groups, which tended to cause more in-
fections, so it is easy to understand why ORIF groups have a higher
rate of unplanned hardware removal. Regarding the reduction
assessment, meta-analysis of six included studies showed no sig-
nificant difference between the two groups and this result was
similar to that found by Richards18
and Wyrsch.12
Ankle functions
were evaluated by seven authors but only two of them used the
same criteria. The meta-analysis result revealed no difference
between the ExFix group and the ORIF group. Crutchfield11
used a
10-point grading scale including pain, stiffness, swelling and sta-
bility and found that patients who had undergone ORIF had higher
scores. Wyrsch et al12
used a clinical scoring system based on
patient pain, function and range of motion and found no difference
between the two surgical methods. Harris7
used Foot function
index and found that more ankle motion limitation was detected in
patients with ExFix compared with patients after ORIF. Koulou-
varis et al16
measured the range of ankle motion by comparing the
injured ankle with the contralateral one and defined limitation as
range of ankle motion 25%. In their study, no difference existed
between two groups. Richards et al18
used Iowa ankle score and
Fig. 3. Funnel plot for the meta-analysis on postoperative infection.
Y.-C. Meng, X.-H. Zhou / Chinese Journal of Traumatology xxx (2016) 1e54
Please cite this article in press as: Meng Y-C, Zhou X-H, External fixation versus open reduction and internal fixation for tibial pilon fractures: A
meta-analysis based on observational studies, Chinese Journal of Traumatology (2016), http://dx.doi.org/10.1016/j.cjtee.2016.06.002
5. Short Form-36 (SF-36) physical function score to evaluate patient
ankle function at 3-, 6-, 12-month follow-up. They observed that
patients undergoing ORIF were significantly better in the 6-month
ankle function score, the 6-month SF-36 physical function score,
and the 12-month ankle function score.
This study has investigated the difference between ORIF and
ExFix in terms of postoperative infection, nonunion, malunion,
reduction, clinical evaluation and unplanned hardware removal.
However, it has some limitations. First, the same outcome may be
measured with different criteria by different authors. For instance,
malunion was defined obscurely in few studies, while wound
infection had an almost homogenous definition throughout all
studies. In our analysis, we tried our utmost to select outcomes
measured with the same criteria to reduce heterogeneity. Second,
it seems impossible for an orthopedic surgeon to conduct ran-
domized controlled trials on patients because of ethical reasons.
Studies we selected are all cohort or case-control studies, whose
design lacks a blinded or random allocation of treatment to
different groups. Third, publication bias cannot be ignored because
published studies which our analysis based on tend to report
positive results rather than negative ones. Fourth, we could not
exclude all confounding factors that may have effects on outcomes
we measured. Studies we selected are all from the US except one,
so the result may not apply to other districts.
In conclusion, we suggest that ORIF has a relatively lower inci-
dence rate of superficial infection, malunion and nonunion, but a
higher rate of hardware removal. In the future, more high quality
randomized trials are needed to confirm our findings and to
compare more factors that can alter the outcome.
Acknowledgments
We would like to thank the authors of the original studies
included in this meta-analysis.
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meta-analysis based on observational studies, Chinese Journal of Traumatology (2016), http://dx.doi.org/10.1016/j.cjtee.2016.06.002