Deficits in recovery of postural stability after stepping are limb- and phase-specific in children with unilateral cerebral palsy.

BACKGROUND: Recovery of postural stability after taking a step is necessary to maintain functional mobility. Although children with cerebral palsy (CP) are at an increased risk of falling, their ability to recover stability following a step is unknown. RESEARCH QUESTION: This study aimed to validate a method to assess step recovery in children with unilateral CP and determine if recovery of postural stability differs between limbs and across phases of step recovery. METHODS: Children with unilateral CP and matched typically developing controls (5-11 y; n=20/group) stood still on force platforms (quiet stance) and completed a forward step with their more-affected limb. Step recovery was divided into dynamic and static phases using vertical ground reaction force. Postural stability was assessed using center of pressure (COP) sample entropy, distance, and velocity of the more-affected (stepping) and less-affected (trailing) limbs in the anteroposterior and mediolateral directions. RESULTS: Vertical ground reaction force during the static phase of step recovery and during quiet stance were not different for either limb and were strongly related (intraclass correlations >0.97, p<0.001), indicating concurrent validity of the step recovery method. Children with CP exhibited impaired recovery of postural stability after stepping, with deficits most pronounced in the mediolateral direction during the dynamic phase in the stepping limb as exhibited by lower COP sample entropy and higher COP distance and velocity (Cohen's d (d) range = 1.46-2.19, all p < 0.001). Deficits were present in the anteroposterior and mediolateral directions in the trailing limb, but they were limited to COP sample entropy and distance and the magnitude of the group differences was less pronounced (d range = 0.35-1.34). SIGNIFICANCE: Step recovery is a valid method to detect deficits in postural stability in children with unilateral CP, and the dynamic phase may be a sensitive target for interventions.

Short-term outcomes of minimally invasive techniques in posterior component separation for ventral hernia repair: a systematic review and meta-analysis.

INTRODUCTION: The objective of this study was to perform a systematic review and meta-analysis to summarize various approaches in performing minimally invasive posterior component separation (MIS PCS) and ascertain their safety and short-term outcomes. METHODS: A systematic literature searches of major databases were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to identify studies that provided perioperative characteristics and postoperative outcomes of MIS PCS. Primary outcomes for this study were: surgical site events (SSE), surgical site occurrence requiring procedural intervention (SSOPI), and overall complication rates. A random-effect meta-analysis was conducted which allows computation of 95% CIs using simple approximation and incorporates inverse variance method with logit transformation of proportions. RESULTS: There were 14 studies that enrolled 850 participants that were included. The study identified rate of SSE, SSOPI, and overall rate of complications of all MIS TAR modifications to be 13.4%, 5.7%, and 19%, respectively. CONCLUSIONS: Our study provides important information on safety and short-term outcomes of MIS PCS. These data can be used as reference when counseling patients, calculating sample size for prospective trials, setting up targets for prospective audit of hernia centers. Standardization of reporting of preoperative characteristics and postoperative outcomes of patients undergoing MIS PCS and strict audit of the procedure through introduction of prospective national and international registries can facilitate improvement of safety of the MIS complex abdominal wall reconstruction, and help in identifying the safest and most cost-effective modification.

Multi-model deep learning approach for segmentation of teeth and periapical lesions on pantomographs.

INTRODUCTION: The fields of medicine and dentistry are beginning to integrate artificial intelligence (AI) in diagnostics. This may reduce subjectivity and improve the accuracy of diagnoses and treatment planning. Current evidence on pathosis detection on pantomographs (PGs) indicates the presence or absence of disease in the entire radiographic image, with little evidence of the relation of periapical pathosis to the causative tooth. OBJECTIVE: To develop a deep learning (DL) AI model for the segmentation of periapical pathosis and its relation to teeth on PGs. METHOD: 250 PGs were manually annotated by subject experts to lay down the ground truth for training AI algorithms on the segmentation of periapical pathosis. Two approaches were used for lesion detection: Multi-models 1 and 2, using U-net and Mask RCNN algorithms, respectively. The resulting segmented lesions generated on the testing data set were superimposed with results of teeth segmentation and numbering algorithms trained separately to relate lesions to causative teeth. Hence, both multi-model approaches related periapical pathosis to the causative teeth on PGs. RESULTS: The performance metrics of lesion segmentation carried out by U-net are as follows: Accuracy = 98.1%, precision = 84.5%, re-call = 80.3%, F-1 score = 82.2%, dice index = 75.2%, and Intersection over Union = 67.6%. Mask RCNN carried out lesion segmentation with an accuracy of 46.7%, precision of 80.6%, recall of 55%, and F-1 score of 63.1%. CONCLUSION: In this study, the multi-model approach successfully related periapical pathosis to the causative tooth on PGs. However, U-net outperformed Mask RCNN in the tasks performed, suggesting that U-net will remain the standard for medical image segmentation tasks. Further training of the models on other findings and an increased number of images will lead to the automation of the detection of common radiographic findings in the dental diagnostic workflow.

Correction: Knowledge, Attitude, and Practices Regarding Radiation and its Hazards Among Orthopaedic Surgeons in India: A Questionnaire-Based Study.

[This corrects the article DOI: 10.1007/s43465-023-01068-1.].

Knowledge, Attitude, and Practices Regarding Radiation and its Hazards Among Orthopaedic Surgeons in India: A Questionnaire-Based Study.

Introduction: Orthopaedic surgeons are among the most frequent users of radiation and are often exposed to X-Ray radiation regularly. There is an overall unsatisfactory level of knowledge, attitude, and practices regarding the same among surgeons. This study aimed to assess the practices among orthopaedic surgeons regarding radiation and its hazards in India. Methodology: This questionnaire-based survey was conducted between March and September 2022. The questionnaire broadly assessed the knowledge, awareness, and practices among orthopaedic surgeons regularly exposed to X-ray radiation. The questionnaire consisted of objective and Likert scale questions which were distributed to the respondents electronically using publicly available contact information. A qualitative review of interpretations obtained from the responses and available evidence in the literature was then performed. Results: The response rate for the survey was 36.4%. 65.9% reported using trunk protection all the time during procedures. 57.1% of respondents reported not using thyroid protection during procedures. 92.3% reported not using protective goggles and 100% did not use appropriate gloves. 76.9% were not issued dosimeters, and only 5.5% of those who had been issued one wore it during radiation procedures. 58.2% reported having a dedicated employee to operate the machine. 86.8% of respondents did not have formal training and 81.3% were not aware of institutes offering formal training. Conclusion: There is very high compliance with the use of protection aprons among the respondents however, the use of other apparel like thyroid shields, protection goggles and gloves was poor. The awareness regarding radiation exposure was also poor as most respondents were not issued dosimeters, however, those issued with one were well aware of their exposure. It is imperative to prioritize both surgeons' and patients' safety where radiation exposure is concerned.

Prefrontal cortex hemodynamic activity during a test of lower extremity functional muscle strength in children with cerebral palsy: A functional near-infrared spectroscopy study.

Children with cerebral palsy (CP) exhibit impaired motor control and significant muscle weakness due to a brain lesion. However, studies that assess the relationship between brain activity and performance on dynamic functional muscle strength assessments in CP are needed. The aim of this study was to determine the effect of a progressive lateral step-up test on prefrontal cortex (PFC) hemodynamic activity in children with CP. Fourteen ambulatory children with spastic CP (Gross Motor Function Classification System level I; 5-11 y) and 14 age- and sex-matched typically developing control children completed a progressive lateral step-up test at incremental step heights (0, 10, 15 and 20 cm) using their non-dominant lower limb. Hemodynamic activity in the PFC was assessed using non-invasive, portable functional neuroimaging (functional near-infrared spectroscopy). Children with CP completed fewer repetitions at each step height and exhibited lower PFC hemodynamic activity across step heights compared to controls. Lower PFC activation in CP was maintained after statistically controlling for the number of repetitions completed at each step height. PFC hemodynamic activity was not associated with LSUT task performance in children with CP, but a positive relationship was observed in controls at the most challenging 20 cm step height. The results suggest there is an altered PFC recruitment pattern in children with CP during a highly dynamic test of functional strength. Further studies are needed to explore the mechanisms underlying the suppressed PFC activation observed in children with CP compared to typically developing children.

Machine learning models to predict surgical case duration compared to current industry standards: scoping review.

BACKGROUND: Surgical waiting lists have risen dramatically across the UK as a result of the COVID-19 pandemic. The effective use of operating theatres by optimal scheduling could help mitigate this, but this requires accurate case duration predictions. Current standards for predicting the duration of surgery are inaccurate. Artificial intelligence (AI) offers the potential for greater accuracy in predicting surgical case duration. This study aimed to investigate whether there is evidence to support that AI is more accurate than current industry standards at predicting surgical case duration, with a secondary aim of analysing whether the implementation of the models used produced efficiency savings. METHOD: PubMed, Embase, and MEDLINE libraries were searched through to July 2023 to identify appropriate articles. PRISMA extension for scoping reviews and the Arksey and O'Malley framework were followed. Study quality was assessed using a modified version of the reporting guidelines for surgical AI papers by Farrow et al. Algorithm performance was reported using evaluation metrics. RESULTS: The search identified 2593 articles: 14 were suitable for inclusion and 13 reported on the accuracy of AI algorithms against industry standards, with seven demonstrating a statistically significant improvement in prediction accuracy (P < 0.05). The larger studies demonstrated the superiority of neural networks over other machine learning techniques. Efficiency savings were identified in a RCT. Significant methodological limitations were identified across most studies. CONCLUSION: The studies suggest that machine learning and deep learning models are more accurate at predicting the duration of surgery; however, further research is required to determine the best way to implement this technology.

Management of tibial plateau fractures: a fresh review.

Tibial plateau fractures are complex injuries which carry significant morbidity and economic burden. They can present complex geometry depending upon the direction of the force and position of the limb and are often associated with significant soft-tissue injury. While the goals of adequate reduction, stable fixation, and early mobilization remain unchanged, the management of these injuries can be challenging even to experienced orthopaedic surgeons. Lacking consensus, this review aims to provide a summary of current state of orthopaedic practice in the face of tibial plateau fractures. A PubMed search for relevant recent articles as well as a reading of classical articles on tibial plateau fractures was carried out. The focus remained on articles concerned with management modalities and recent advances. A review of some classification systems was also done and included. A great majority of these fractures need operative fixation while respecting the soft tissues. Numerous methods have been reported in the literature including but not limited to plates, screws, external fixators, arthroscopy assisted methods, balloon-cement tibioplasty, or a combination thereof. There is a shortage of randomized controlled trials comparing various operative methods. This article provides a review of various techniques and latest advances made in the management of tibial plateau fractures. The key to achieving optimal functional outcome is using a tailored approach to the individual patient accounting for factors related to the injury pattern, type of host, surgical skills and experience, and local availability of implant devices while taking care of soft tissue. While there is no gold standard, a staged procedure is recommended with early spanning and definitive fixation at later stage by any appropriate methods while respecting the soft tissue, achieving anatomical reduction and adequate fixation and, early rehabilitation.

Prevalence and Impact of Gastrointestinal Manifestations in COVID-19 Patients: A Systematic Review.

Background and objective: The aim of this study is to systematically analyze and summarize the implications of COVID-19 on the digestive system by quantitatively evaluating the prevalence of gastrointestinal symptoms such as nausea, vomiting, abdominal pain, constipation, diarrhea, anorexia. reported in COVID-19 cases. We simultaneously investigated other variables to determine the association of such symptoms in COVID-19 patients which can potentially influence the disease prognosis and outcome. This systematic review presents an updated literature on the issue as it requires more scientific discussion in order to better inform the medical community and authorities so that appropriate measures can be taken to control the virus outbreak. Methods: MEDLINE database was searched to identify relevant articles. Data was analyzed and synthesized from the 16 eligible studies which exclusively reported GI symptoms in COVID-19 patients along with the disease prognosis. A meta-analysis of studies having adequate information regarding the prevalence of specific GI symptoms in association with other relevant independent variables was performed. Results: From the search strategy, we identified 16 articles which fit our eligibility criteria comprising of 10 cross-sectional studies, 2 cohort study, 1 RCT and 3 observational studies. From these pooled studies, 6 articles exclusively talked about COVID-19 patients in which GI symptoms were reported and adequately discussed. In a total of 3646 patients, GI symptoms were documented in (16.2%-10.1%) patients. The most prevalent GI symptom was diarrhea (47%) but the most common clinical manifestation reported was fever (77.4%). Among the adult patients, hypertension (11.6%) was the most frequently reported comorbidity. Presence of viral RNA in stool sample was noted in 16.7% patients with GI symptom. In patients who complained of having GI symptoms, an abnormal liver function was largely observed, with an elevated ALT level in (10.9%) and an elevated AST in (8.8%) of the patients. Evidence of vertical transmission (14.2%) was reported in one study which highlights the extent and mode of viral transmission. It was observed that a great majority of the patients in the 6 studies reporting specifically on patients with GI symptoms were on antiviral therapy (68.6%) as the standard disease management protocol but the eventual disease outcome as in this case died (8.4%), discharged (45.6%) was not linked to just one therapeutic factor but other indicators of disease severity such as positive chest CT findings (87.82%) have led to a poor disease prognosis which was noted in (28.9%) severe patients with GI symptoms compared to (71.1%) non-severe COVID-19 patients with GI symptom. Conclusion: Presence of GI symptoms in COVID-19 patients has shown to have a positive association with the poor disease prognosis likely as a result of direct viral toxicity. It is important for the physicians to recognize digestive symptoms as an important characteristic in COVID-19 patients. Hence, precise and targeted documentation of GI symptoms and viral stool sample investigations should be performed in order to understand the rapidly evolving disease symptomology.

K-Wire-Based External Fixator for Management of Salter-Harris Type-II Distal Femur Physeal Injury.

We present a case of a 16-year-old male with a Salter-Harris type II physeal slip of the distal femur managed with closed reduction and K wire and clamp-based external fixator. Knee range of motion exercises were initiated after one week. The union was observed at 10 weeks, and implant removal was done on an outpatient basis. At one year follow-up, the patient had good clinical and radiological outcomes. The K-wire-based external fixator frame is an effective fixation method for distal femur physeal slips in older children, providing favorable radiological and functional outcomes.

Patellar resurfacing and kneeling ability after total knee arthroplasty: a systematic review.

BACKGROUND: Difficulty kneeling following total knee arthroplasty (TKA) remains highly prevalent, and has cultural, social, and occupational implications. With no clear evidence of superiority, whether or not to resurface the patella remains debatable. This systematic review examined whether resurfacing the patella (PR) or not (NPR) influences kneeling ability following TKA. METHODS: This systematic review was conducted by following PRISMA guidelines. Three electronic databases were searched utilizing a search strategy developed with the aid of a department librarian. Study quality was assessed using MINROS criteria. Article screening, methodological quality assessment and data extraction were performed by two independent authors, and a third senior author was consulted if consensus was not reached. RESULTS: A total of 459 records were identified, with eight studies included in the final analysis, and all deemed to be level III evidence. The average MINORS score was 16.5 for comparative studies and 10.5 for non-comparative studies. The total number of patients was 24,342, with a mean age of 67.6 years. Kneeling ability was predominantly measured as a patient-reported outcome measure (PROM), with two studies also including an objective assessment. Two studies demonstrated a statistically significant link between PR and kneeling, with one demonstrating improved kneeling ability with PR and the other reporting the opposite. Other potential factors associated with kneeling included gender, postoperative flexion, and body mass index (BMI). Re-operation rates were significantly higher in the NPR cohort whereas PR cohorts had higher Feller scores, patient-reported limp and patellar apprehension. CONCLUSION: Despite its importance to patients, kneeling remains not only under-reported but also ill-defined in the literature, with no clear consensus regarding the optimum outcome assessment tool. Conflicting evidence remains as to whether PR influences kneeling ability, and to clarify the situation, large prospective randomized studies are required.

K Wires or Cannulated Screws for Fixation of Lateral Condyle Fractures in Children: A Systematic Review of Comparative Studies.

Introduction: Lateral condyle fractures in children have been typically been treated operatively using Kirschner wires (K wire) or cannulated screws (CCS); however, a definitive choice of implant remains a matter of debate. This systematic review aims to determine if union and functional outcomes of these fractures are better with screw fixation. Methodology: A search of PubMed, Medline, Cochrane, and Google scholar was performed in March 2021. The results were screened by title and abstract, and relevance and a quality assessment of the data were performed for the articles meeting the inclusion criteria. Articles comparing radiological and functional outcomes of lateral condyle fractures treated with K wires or screws were included for examination. Articles were excluded if they did not compare outcomes of K wires and CCS together, or were in a language other than English, technical notes, case reports, and articles, which describe the use of fixation methods other than K wire or CCS as well as biomechanical studies were also excluded. Risk of bias and quality assessment of included articles were also done. Results: Seven clinical studies were included. 44.4% (n = 4) were retrospective review of records with level III evidence (77.7%, n = 7). Only two included articles had good-quality assessment scores. Union was reported in 85.7% % in K wire group and 99.6% in CCS group. Functional outcomes were not statistically significant between the two groups. Conclusion: Using screws to fix lateral condyle provides better union; however, there is no difference in the functional outcomes and complication rate between the two. Using screws or buried K wires adds the burden of an additional procedure for removal.

A Simple Technique to Remove an Incarcerated Ceramic Liner in Revision Hip Arthroplasty.

Extraction of a well-fixed ceramic liner during revision total hip arthroplasty can be technically challenging, particularly when acetabular fixation screws prevent en bloc removal of the shell and insert without causing collateral damage to the adjacent pelvic bone. It is also important to remove the ceramic liner intact, as ceramic debris left in the joint may cause third body wear with premature articular wear of the revised implants. We describe a novel technique to extract an incarcerated ceramic liner when previously described strategies prove ineffective. Knowledge of this technique will help surgeons avoid unnecessary damage to the acetabular bone and optimize prospects for stable implantation of revision components.

Metallosis and Nonunion: A Case Series and Literature Review.

Metallosis, defined as the presence of free metal particles in the tissue, including bone and soft tissue, is a rare phenomenon seen in orthopedic practice. It is more commonly seen in arthroplasty surgeries, but its occurrence in the presence of other metal implants is also well recognized. Multiple hypotheses are suggested to explain the genesis of metallosis, but it is traditionally believed that abnormal contact between the metal surfaces leads to abrasive wear causing the release of metal particles into the surrounding tissue eliciting foreign body reactions from the body's immune system. The consequences can be local effects, which can be asymptomatic soft tissue lesions, or lead to significant osteolysis, tissue necrosis, joint effusion, and large soft tissue masses, causing secondary pathological effects. The systemic distribution of these metal particles can also contribute to the clinical picture. The literature contains multiple case reports of metallosis following arthroplasty surgeries, but there is limited information on metallosis resulting from osteosynthesis of fractures. In this review, we are presenting our experience with a few patients who developed nonunion following the index surgeries and on revision were found to have metallosis as well. It is difficult to postulate whether metallosis was contributory to the nonunion or the other way around or whether the occurrence of nonunion in face of metallosis was a pure coincidence. Additionally, one of our patients had a positive intraoperative culture, further complicating the picture. In addition to the case series, we present a succinct review of the literature on metallosis found in previous studies.

Segmentation for Multi-Rock Types on Digital Outcrop Photographs Using Deep Learning Techniques.

The basic identification and classification of sedimentary rocks into sandstone and mudstone are important in the study of sedimentology and they are executed by a sedimentologist. However, such manual activity involves countless hours of observation and data collection prior to any interpretation. When such activity is conducted in the field as part of an outcrop study, the sedimentologist is likely to be exposed to challenging conditions such as the weather and their accessibility to the outcrops. This study uses high-resolution photographs which are acquired from a sedimentological study to test an alternative basic multi-rock identification through machine learning. While existing studies have effectively applied deep learning techniques to classify the rock types in field rock images, their approaches only handle a single rock-type classification per image. One study applied deep learning techniques to classify multi-rock types in each image; however, the test was performed on artificially overlaid images of different rock types in a test sample and not of naturally occurring rock surfaces of multiple rock types. To the best of our knowledge, no study has applied semantic segmentation to solve the multi-rock classification problem using digital photographs of multiple rock types. This paper presents the application of two state-of-the-art segmentation models, namely U-Net and LinkNet, to identify multiple rock types in digital photographs by segmenting the sandstone, mudstone, and background classes in a self-collected dataset of 102 images from a field in Brunei Darussalam. Four pre-trained networks, including Resnet34, Inceptionv3, VGG16, and Efficientnetb7 were used as a backbone for both models, and the performances of the individual models and their ensembles were compared. We also investigated the impact of image enhancement and different color representations on the performances of these segmentation models. The experiment results of this study show that among the individual models, LinkNet with Efficientnetb7 as a backbone had the best performance with a mean over intersection (MIoU) value of 0.8135 for all of the classes. While the ensemble of U-Net models (with all four backbones) performed slightly better than the LinkNet with Efficientnetb7 did with an MIoU of 0.8201. When different color representations and image enhancements were explored, the best performance (MIoU = 0.8178) was noticed for the L*a*b* color representation with Efficientnetb7 using U-Net segmentation. For the individual classes of interest (sandstone and mudstone), U-Net with Efficientnetb7 was found to be the best model for the segmentation. Thus, this study presents the potential of semantic segmentation in automating the reservoir characterization process whereby we can extract the patches of interest from the rocks for much deeper study and modeling to be conducted.

Patient Preferences Regarding Telemedicine to In-person Consultation: A Questionnaire-Based Survey.

Introduction: Telemedicine has been evolving over the last two decades; however, with the advent of the COVID 19 pandemic, its utility and acceptance have drastically increased. Most studies report increasing acceptability and satisfaction rates. This study aimed to assess patient preferences regarding telemedicine to in-person consultations and to attempt to assess the factors driving these preferences. Material and Methods: A questionnaire-based cross-sectional study was conducted for patients who had both teleconsultation and in-person consultation in the orthopedic outpatient. After obtaining consent to participate in the study, the patients were divided into broad clinical categories and responses were recorded regarding the treatment of illness by the doctor and opinions regarding telemedicine. Most questions were in yes/no or a Likert-based questionnaire. Mean, median, percentage and proportions were used for statistical analysis of the data. Results: The study group included 264 patients, with the majority with fractures and dislocations. Most patients (55.7%) were comfortable using the software for teleconsultation, and half the respondents found telemedicine convenient. A large percentage of the study group preferred in-person consultation to teleconsultation (58.7%), and the primary reasons for discontinuing teleconsultation were dissatisfaction during the interaction with the doctor and poor connectivity to telecommunication networks. Conclusion: Telecommunication has high acceptance and satisfaction, but many factors limit its acceptance in developing countries.

Automated Real-Time Identification of Medicinal Plants Species in Natural Environment Using Deep Learning Models-A Case Study from Borneo Region.

The identification of plant species is fundamental for the effective study and management of biodiversity. In a manual identification process, different characteristics of plants are measured as identification keys which are examined sequentially and adaptively to identify plant species. However, the manual process is laborious and time-consuming. Recently, technological development has called for more efficient methods to meet species' identification requirements, such as developing digital-image-processing and pattern-recognition techniques. Despite several existing studies, there are still challenges in automating the identification of plant species accurately. This study proposed designing and developing an automated real-time plant species identification system of medicinal plants found across the Borneo region. The system is composed of a computer vision system that is used for training and testing a deep learning model, a knowledge base that acts as a dynamic database for storing plant images, together with auxiliary data, and a front-end mobile application as a user interface to the identification and feedback system. For the plant species identification task, an EfficientNet-B1-based deep learning model was adapted and trained/tested on a combined public and private plant species dataset. The proposed model achieved 87% and 84% Top-1 accuracies on a test set for the private and public datasets, respectively, which is more than a 10% accuracy improvement compared to the baseline model. During real-time system testing on the actual samples, using our mobile application, the accuracy slightly dropped to 78.5% (Top-1) and 82.6% (Top-5), which may be related to training data and testing conditions variability. A unique feature of the study is the provision of crowdsourcing feedback and geo-mapping of the species in the Borneo region, with the help of the mobile application. Nevertheless, the proposed system showed a promising direction toward real-time plant species identification system.

Effectiveness of Calcium Sulfate and Hydroxyapatite Composite in Collapse Prevention in Osteonecrosis of Femoral Head.

Introduction Calcium-sulfate-hydroxyapatite bioceramics have been widely used as void fillers in bone. However, their effectiveness as void fillers in core decompression for osteonecrosis of the femoral head (ONFH) in preventing femoral head collapse prevention has limited evidence. The current study investigates the effectiveness of calcium-sulfate-hydroxyapatite bioceramics as a void filler in the core decompression procedure for ONFH. Methods We retrospectively reviewed the clinical and radiological records of ONFH patients that underwent core-decompression using either autologous iliac crest cancellous bone graft or calcium-sulfate-hydroxyapatite bioceramic paste as void fillers with at least one-year follow-up. The primary outcome of this study was the radiological progression of collapse in the last available standard anteroposterior (AP) radiographs of the hip. The collapse progression was compared between the two groups based on void fillers. Results This study included patient records with 44 hip joints that underwent core decompression. There were five female and 33 male patients. The mean age was 29.1±6.3 years. The mean follow-up duration was 21.4±3.4 months. No significant differences in collapse progression were observed between the two groups based on void fillers. Conclusion The use of calcium-sulfate-hydroxyapatite as a void filler in core decompress for ONFH is not superior to the autologous cancellous bone in terms of collapse prevention and mechanical support. Further modifications in the core decompression techniques and well-planned prospective studies would help establish sound recommendations.

Investigating differences in symptomatology and age at diagnosis of obstructive sleep apnea in children with and without autism.

INTRODUCTION: Obstructive sleep apnea (OSA) is common in autism spectrum disorder (ASD). Children with OSA can present with a range of symptoms including loud snoring, excessive daytime sleepiness, and changes in cognitive function. Some of these symptoms can overlap with and exacerbate symptoms of ASD, potentially delaying OSA diagnosis in children with both conditions. OBJECTIVE: The primary objective of this study was to assess between-group difference in OSA symptomatology and age at OSA diagnosis in children with and without ASD. METHODS: A retrospective chart review was conducted on 166 pediatric patients (<18 years) with OSA undergoing adenotonsillectomy at a single academic institution between 2019 and 2021. The control group consisted of 91 patients (54.9% male) without ASD. The ASD group included 75 patients (88.0% male). Autism severity was scored on a 1-4 scale using a novel methodology. Statistical analyses included Wilcoxon rank sum tests for continuous variables, chi-squared tests for categorical variables, and multivariable analyses as needed. RESULTS: There was a significant between-group difference in total number of reported OSA symptoms (p < 0.001), with more symptoms reported in patients with ASD. Within the ASD group, lower autism severity was associated with an increased number of reported OSA symptoms (p = 0.006). There was not a significant between-group difference in age at OSA diagnosis (p = 0.999); however, lower autism severity was associated with an increased age at diagnosis (p = 0.002). CONCLUSION: These findings suggest that OSA may present with a higher symptom burden in children with ASD, particularly for children with lower ASD severity, who often experience delays in OSA diagnosis. These findings and their clinical implications merit further explanation.